3.  ■^^^'-^^JU.^^yi.  J.  J^-'h-: 


Library  of  Health 

Complete  Guide  to  Prevention  and  Cure 

of  Disease  p 


CONTAINING    PRACTICAL    INFORMATION    ON 

Anatomy,  Physiology  and  Preventive  Medicine;  Curative   Medicine,  ftrs 
Aid  Measures,  Diagnosis,  Nursing,  Sexology,  Simple  Home  Remedies, 
Care  of  the  Teeth,  Occupational  Diseases,  Garden  Plant  Remedies, 
Alcohol  and  Narcotics,  Treatment  by  Fifteen  Schools  of  Medi- 
cine,  Beauty  Culture,   Physical   Culture,   the   Science  of 
Breathing  and  the  Dictionary  of  Drugs. 


FULLY  ILLUSTRATED  WITH  HALF  TONE 
AND  COLORED  PLATES 

TWENTY  BOOKS— ONE  VOLUME 


EDITED   BY 
B.  FRANK  SCHOLL,  Ph.G.,  M.D. 

Graduate  of 
Jefferson  Medical  College,  and  Philadelphia  College  of  Pharmacy 


1921     EDITION 


HISTORICAL  PUBLISHING  CO. 

PHILADELPHIA.  PA.. 
U.S.  A 


533 


Copyright,  1916 

E.  J.  STANLEY 

All  Rights  Reserved,  Including  that  of  Translation  into  Foreign  Languages, 
•  Including  the  Scandinavian 


1921    EDITION 


Entered  at  Stationer's 

Hall,  London 

March,     ]91t) 


Wide  Thanks  to  those  that  Have  Gone  Before 


The  use  of  home  medical  books  has  now  become  general  and 
they  are  recognized  as  being  just  as  essential  to  the  protection 
of  the  family,  the  care  of  health,  the  prevention  of  disease,  the 
care  of  the  young  child;  in  giving  assistance  in  the  absence  of 
the  doctor,  and  in  preventing  unnecessary  sickness  and  sufifering 
and  the  saving  of  life  itself,  as  the  scientific  text  books  are  essen- 
tial to  the  physician. 

This  knowledge  is  not  intended  to  make  doctors  out  of  lay- 
men or  to  encourage  self  medication  except  in  emergency.  It 
aims  to  teach  prevention  rather  than  cure.  It  is  a  well-known  fact 
that  over  fifty  per  cent,  of  the  sickness  that  comes  to  the  home 
is  unnecessary  and  preventable  if  the  people  have  the  proper 
knowledge.  The  right  kind  of  information  in  the  hands  of  the 
mother  will  prevent  unnecessary  sickness,  take  care  of  accidents 
and  emergencies,  and  save  thousands  of  lives,  when  the  doctor 
cannot  be  reached  in  time ;  it  also  teaches  the  care  and  nursing  of 
the  sick  and  the  rearing  of  children  in  thousands  of  homes  that 
cannot  afford  the  professional  nurse. 

It  may  be  said  that  during  the  past  five  years  the  treatment 
and  ctire  of  many  diseases  has  entirey  changed ;  that  more 
important  discoveries  and  new  and  successful  methods  for  the 
curing  of  disease  have  been  proven  and  adopted  during  this  time 
than  in  any  similar  period  during  the  past  century.  The  old 
method  of  treating  fever  was  by  shutting  the  patient  in  a  tight 
room,  smothering  him  with  bedclothing,  allowing  no  ice  water, 
and  dosing  with  medicine.  The  latest  treatment  whether  the  fever 
is  typhoid  in  its  character,  pneimionia,  or  malaria  fever,  is  to 
have  the  patient  covered  lightly  with  a  sheet,  the  room  perfectly 
ventilated  and  the  temperature  largely  controlled  by  external 
applications. 

Measles  is  now  treated  by  simple  methods.  The  treatment 
for  Scarlet  Fever  is  materially  changed  and  fatalities  greatly 
reduced.  So  we  might  mention  many  others.  It  is  not  too  much 
to  say  that  the  mortality  of  all  diseases  has  been  diminished 


greatly  by  the  new  treatments  and  nursing  adopted  within  the 
hist  five  years.  The  tendency  of  modern  treatment  is  toward 
preventive  medicine  and  careful  nursing. 

Of  every  i,ooo  babies  born  in  this  country,  124  die  before 
they  are  a  year  old.  An  average  of  three  hundred  thousand  babies 
under  a  year  old  died  yearly  in  the  United  States  the  past  few 
years.  Half  of  this  number  could  have  been  saved  if  every 
mother  in  every  home  knew  how  to  take  proper  precaution,  and 
give  proper  care  and  nursing. 

If  a  child  should  be  exposed  to  any  disease — for  instance,  the 
Measles — the  "Library"  tells  you  just  how  many  days  before 
the  rash  appears  and  how  it  can  affect  others  exposed  to  it. 
By  having  this  information  the  mother  can  call  the  doctor  in 
time  and  can  more  intelligently  assist  and  co-operate  with  him. 

Then  just  think  of  the  accidents  that  are  happening  every 
dav  antl  the  doctor  may  be  miles  away.  We  give  in  the  "Library" 
the  quickest,  best  and  the  most  efficient  treatments  in  accidents 
and  emergencies,  in  the  absence  of  a  doctor,  and  it  is  the  duty 
of  everyone  to  know  what  to  do  for  the  first  aid  to  the  sick  and 
injured. 

If  someone  should  take  poison — for  instance,  "Carbolic 
■  Acid"  or  "Lye,"  which  are  very  common  in  the  home — perhaps 
your  child  takes  a  drink  of  one  of  them  by  mistake.  You  call  in 
a  doctor  and  by  the  time  he  gets  there  it  may  be  too  late,  but,  by 
turning  to  "POISONS,"  you  find,  "For  Carbolic  Acid  take  Epsom 
Salts,"  and  "for  Lye  take  Oil."  This  information  may  save  a 
life. 

And  so  on  with  every  kind  of  emergency.  They  happen  every 
day,  especially  with  children.  There's  nev^er  a  wash-day  that 
passes  over  the  land  but  what  there  are  numbers  of  cases  of  chil- 
dren getting  hold  of  ammonia.  If  your  little  one  took  a  swallow 
from  the  ammonia  bottle,  you  couldn't  grab  it  in  your  arms  the 
moment  it  screamed  and  run  two  blocks  to  the  doctor  in  time  to 
do  any  good,  but  yoti  could  grab  the  vinegar  bottle — that's  always 
handy — and  give  it  a  good  swallow  of  vinegar,  which  will  im- 
mediatelv  coimteract  the  ammonia.  No  home  should  be  without 
stich  information. 

What  would  you  do  in  the  absence  of  a  doctor?  Ask  your- 
self any  question  about  health  or  life  and  turn  to  the  "Library" 
for  your  answer. 

Did  you  ever  stop  to  think  that  one  could  bleed  to  death  in 
three  to  seven  minutes,  before  you  could  get  medical  help?  Here 
is  given  the  simplest  and  best  information  on  just  where  to  press. 
to  stop  the  flow  of  blood  from  anv  part  of  the  body;  and  if 
you  know  just  how,  you  can  stop  it  with  your  own  thumb  or 


finger  or  by  using  a  simple  tourniquet  until  you  can  procure  as- 
sistance; then  you  can  wait  for  the  doctor — hours,  if  necessary. 

It  is  only  too  true  that  a  large  majority  of  our  women  are 
raised  in  an  atmosphere  of  false  modesty  that  prevents  them 
from  having  the  necessary  knowledge  to  take  the  proper  care 
of  themselves  and  avoid  various  diseases  and  disorders.  Thou- 
sands of  women  have  questions  they  would  like  answered  that 
they  will  not  ask  their  local  physician  on  account  of  embarrass- 
ment, also  expense,  and  this  information  is  absolutely  essential 
to  their  personal  health.  These  minor  troubles  through  neglect 
oftentimes  become  chronic  and  incurable,  while,  if  taken  at  the 
start,  they  are  easy  to  remedy. 

Watch  carefully  every  little  headache,  cough,  chill,  pain  or 
fever — they  may  lead  to  something  serious.  Prevention  is  better 
than  cure  and  Prcz'eiitioii  begins  at  home.  The  index  under  the 
HEADINGS  will  direct  you  to  the  proper  place,  where  you  can 
obtain  the  information  you  need  to  guide  you. 

The  mother  is  the  one  who  looks  after  the  health  of  the 
family.  The  mother  is  with  the  children  twenty-four  hours  in 
the  day  and  feels  most  responsible  in  case  of  sickness.  That  is 
why  the  "Library"  is  placed  in  the  homes — IT  IS  FOR  THE 
WIFE  and  FOR  THE  MOTHER. 

If  the  husband  comes  home  sick,  or  a  child  is  ill,  the  wife  is 
expected  to  do  the  nursing.  How  is  she  going  to  do  this  if  she 
never  had  any  experience  with  sickness?  The  Nursing  Depart- 
ment will  tell  her.  It  teaches  how  to  make  poultices,  ointments, 
plasters,  syrups,  etc. ;  how  to  change  the  sheets,  making  the  pa- 
tient comfortable,  and  how  to  feed  the  sick.  Of  the  most  value 
to  the  sick  room  is  the  nurse ;  she  should  understand  how  to  pre- 
pare food  and  diet  for  the  particular  ailment  of  the  patient,  and 
to  assist  the  doctor  in  battling  with  disease  and  restoring  health. 
"Library  of  Health"  gives  you  all  this  information  in  a  plain, 
practical  way  that  anyone  can  understand. 

Knowing  from  our  experience  that  the  medical  specialists 
and  teachers  who  stand  at  the  head  of  their  profession  write  in 
language  of  technical  expression,  it  has  been  necessary  for  the 
publishers  to  seek  the  services  of  a  competent  editorial  stafif,  who 
have  put  the  technical  and  scientific  knowledge  in  a  plain,  prac- 
tical form,  so  that  anyone  can  understand. 

JVe  zvish  to  extend  wide  thanks  to  the  contributors  to  this 
work  and  to  the  professors,  physicians,  specialists  and  lecturers 
of  Universities  and  Colleges  throughout  the  world,  some  of  whom 
have  gone  before,  and  the  recognized  standard  home  medical 
works  published  in  England,  Germany,  France,  Spain  and  Amer- 
ica, from  whom  our  editors  have  gleaned,  as  follows: 


Seserano  Lachapelle,  M.D., 

Professor  of  Anatomy,  Montreal,  Canada. 

Benito  Bordas,  M.D., 

Specialist  in  Febrile  Diseases,  Cuba. 

Wm.  L.  Powell,  M.D., 

Specialist  in  Internal  Medicine. 

George  Noble,  IM.D., 

Professor  of  Chest  Diseases,  Vienna. 

H.  Webster  Jones,  M.D., 

Specialist  in  Diseases  of  Children,  London. 

Prof.  Van  Werth, 

Specialist  in  Venereal  Diseases,  Dresden. 

John  Forsyth  Little,  M.R., 

Demonstrator  of  Anatomy,  Philadelphia. 

Silverio  Dominguez,  M.D., 

Specialist  in  Constitutional  Diseases,  Buenos  Aires. 

Prof.  M.  Hoff, 

Specialist    in    Consumption    and    Germ    Treatment    of 
Disease,  Vienna. 

C  C.  Vanderbeck,  M.D.,  Ph.G., 

Formerly  Lecturer  on  Hygiene,  Philadelphia. 

Domingo  Orvananos,  M.D., 

Specialist  in  Diseases  of  the  Circulatory  System. 

A.  O.  Mencki,  M.D., 

Experimental  Medicine,  Petrograd,  Russia. 

Aubrey  W.  Marchand,  D.C., 

Chiropractice,  Davenport,  Iowa. 

Anne  McFarland  Sharpe,  B.A.,  M.D., 

Author  of  "Nervous  Troubles  Among  Women." 

Jose  Peon  Y.  Contreras,  ]\1.D., 

Specialist  in  Tropical  Diseases,  Mexico. 


Joseph  G.  Richardson,  M.D., 
Professor  of  Hygiene. 

A.  M.  Stafford,  M.D., 

Specialist  in  Diseases  of  the  Nose  and  Throat. 

F.  E.  Miller,  A.M.,  M.D., 

Consulting    Physician,     St.    Joseph's    Hospital,    New 
York  City. 

Eugene  Davis,  M.D., 

Formerly  Specialist  in  Polyclinic  Hospital,  Philadelphia. 

L.  E.  Fortier,  M.D., 

Ex-Surgeon  Pennsylvania  Railroad  Co. 

E.  F.  Roeber.  M.D., 

Kneipp  System  of  Natural  Plealing. 

Jean  Latauche,  M.D., 

Lecturer  on  Clinical  Diseases,  Plospital  of  Charity,  Paris. 

S.  Ivi'asaki,  M.D., 

Nagasaki,  Japan. 

El  Medico  del  Hogar. 

Hering's  Domestic  Physician. 

Warren's  Household  Physician. 

Greer's  Physician  in  the  Home. 

Chavasses'  "Manual  for  Wives  and  Mothers." 

Woods'  Vitalogy. 

American  Family  Physician. 

Newell's  Family  Doctor. 

Bilz's  Natural  Healing. 

Kelley's  Domestic  Medical  Practice. 


Gunn's  Revised  Family  Physician. 
Medicology. 

Standard  Family  Physician. 
■  And  many  others. 


GENERAL   ARRANGEMENT 


Although  contained  in  one  volume  this  work  is 
divided  into  twenty  Books,  which  in  their  turn  are 
subdivided  into  chapters  or  parts. 

At  the  back  of  the  whole  work  will  be  found  a 
complete  General  Index  of  all  matters  contained  in 
the  different  Books  and  their  subdivisions,  so  that 
any  disease  or  any  remedy  in  any  part  of  the  work 
may  be  quickly  located.  But,  in  addition  to  this 
General  Index,  each  chapter  or  part  is  prefixed  with 
a  special  index  of  its  own,  thus  giving  immediate 
location  of  items  to  be  consulted  in  the  special  sub- 
ject at  the  time  under  consideration.  For  example, 
let  us  take  the  common  disease  Asthma.  On  con- 
sulting the  General  Index  we  find  the  main  article 
to  be  on  page  523.  Turning  to  the  index  at  the  be- 
ginning of  this  chapter  (Part  VI  of  Book  IV)  we 
may  find  the  causes,  symptoms  and  varieties  of 
Asthma. 

If  what  we  wish  is  not  found  in  this  general 
article,  we  again  refer  to  the  General  Index;  and  we 
have  special  treatments  of  the  disease  in  other  parts 
of  the  work,  such  as  Simple  Remedies,  Prescriptions, 
Homeopathic  Treatment,  Exercises,  etc.  This  plan 
has  been  carried  out  all  through  the  work. 


IMPORTANT 


READ  CAREFULLY 


A  TTENTION  is  directed  to  the  fact  that  all  through 
-^^  this  book  the  doses  mentioned  are  for  ADULTS, 
except  where  the  treatment  is  specifically  for  a  child. 

PLEASE  NOTE  particularly  the  footnote  on  pages 
1233  to  124S  inclusive. 

Also  note   full  directions  given  on  pages  1224  and 
1 7 19,  to  determine  doses  for  children. 


Table  of  Contents 


Book           I    The   Human   Body 35 

A  Description  of  the  Colored  Anatomical  Charts  Comprising 
the  Manikin  Accompanying  this  Work 

Book          n    Anatomy  and  Physiology 73 

Book        III    Preventive   Medicine 1271 

Part          I     The  Prevention  of  Disease  by  Elimination  of  Disease  Carriers.  127 

Part        II     Water  in  Its  Hygienic  Relations 147 

Part      III     Pure  Air  as  a  Condition  of   Healtli 181 

Part      IV     The  Hygiene  of   Foods  and   Drinks    207 

,         Part        V     Outward  Enemies  to  Health 231 

Part      VI     The  Germ  Theory  of  Disease 237 

Part     VII     The  Construction  of   Sanitary  Dwelling  Houses 247 

Part  VIII     Importance  of  the  Removal  of  Excreta.- 257 

Book         IV    Curative   Medicine 261 

Part         I    The   Eruptive    Diseases 261 

Part        II     The   Constitutional    Diseases 353 

Part      III     Diseases  of  the  Nervous  System 401 

Part      IV     Diseases  of  the  Eye,  Ear  and  Nose 4SI 

Part        V     Diseases  of  the  Circulatory  and  Absorbent  Systems 493 

Part      VI     Diseases  of  the  Respiratory   System 523 

Part    VII     Diseases  of  the  Digestive  System 555 

Part  VIII     Diseases  of  the  Genito-Urinary  System,  Including  the  Venereal 

Diseases    599 

Part      IX     The  "Urine  in  Health  and  Disease  with  a  Series  of  Home  Tests.  631 

Part        X     Diseases   Peculiar  to   Women 639 

Part      XI     Diseases  of  the  Skin,  Hair  and  Nails 711 

Part    XII     Diseases  of  the  Bones  and  Muscles •. 733 

Part  XIII     Diseases  of   Children 757 

Part  XIV     Diseases  and  Conditions  which  may  be  Treated  Surgically 783 

Part    XV     Anesthetics  and   Soporifics   813 

Book           V    First  Aid  to  the  Injured 825 

Part          I     Accidents  and  Emergencies 825 

Part        II     Bandaging     873 

Part      HI     Poisons  and  Their  Antidotes 881 

Book         VI    The  Diagnosis  of  Disease 917 

With   a    Tal)Ie    of    Symptoms    Arranged    Alphabetically    for 
Ready  Reference 

Book       VII    The  Sick  Room  in  the  Home 985 

Part          I     A  Treatise  on  the  Science  of  Nursing   (185 

Part        II     The  Care  of  the  Convalescent 1043 

Part      III     Diet  in  its  Relation  to  Disease  with  a  Table  of  Suitable  and 

Unsuitable  Foods  for  Nearly  Fifty  Diseases 1059 

Part      IV    The  Care  of  the  Aged 1087 

V 


vi  TABI.E    OF    CONTENTS. 

Book     Vin    Sexology 1107 

Part  I     Courtship   and   Matrimony  1107 

Part  II  The  Mother  and  the  Child,  Being  a  Treatise  on  the  Care  of 
the  Mother  Before  and  During  Child-birth  and  of  the  Child 
Through  Infancy   1129 

Book        IX    Home  Administration  of  Medicine 1199 

Part         I    The  Ideal  Home  Medicine  Chest  1199 

Part        II     Foods  and  Their  Digestion 1209 

Part  III  Tables  of  Weights  and  Measures,  Doses,  Pulse  Rate,  Den- 
tition, etc.,  etc 1223 

Part      IV     Standard  Medical  Prescriptions  and  Simple  Formulas 1233 

Part        V     New  Remedies,  Their  Properties,  Doses  and  Manner  of  Using.   1251 

Book  X    Simple  Remedies  for  Many  Ills.     What  To  Do  in  the 

Absence  of  a  Doctor 1259 

Book        XI    The  Care  and  Diseases  of  the  Teeth 1301 

Book      XII    The  Occupational  Diseases 1331 

With  a  Table  of  Industrial  Poisons  arranged  alphabetically, 
showing  the  effects  produced  by  each  and  giving  special 
measures  of  relief  therefrom 

Book     Xin    Medical  Materials,  Their  Properties  and  Uses 1375 

Part  I     Inorganic  or  Mineral   Materials   1375 

Part       II     Organic  or  Vegetable  Materials  1385 

Book      XIV    Alcohol   and   Narcotics 1479 

The  Newest  and  Best  Cures  for  the  Drink,  Tobacco  and  Drug 
Habits 

Book        XV    The  Treatment  of  Disease  hy  Various  Schools  of  Medicine. 1495 

Part  I  Homeopathy    1495 

Part        II  Osteopathy    1508 

Part      III  Massage  1518 

Part      IV  Chiropractic    1524 

Part        V  Hydrotherapy    1527 

Part      VI  Eclectic  Medicine  1545 

Part    VII  The  Japanese  Method   ISS7 

Part  VIII  The  German  Home  Treatment 1571 

Part      IX  Electricity  and  the  X-Ray 1588 

Part        X  Mental  Healing,  Including  Mesmerism,  Hypnotism,  Mind  Cure, 

Christian  Science  and  Telepathy IS9I 

Part      XI  Human  Science:  Phrenology,  Physiognomy  and  Palmistry....  1604 

Book  XVt    Beauty  Culture  and  Self -Care  for  "Women 1623 

Book  XVII    Physical   Culture    and   Body -Building 1649 

Book  XVm  The  Science  of  Breath  and  a  Series  of  Remedial  Exercises .  1689 

Book  XIX    Jiu-Jitsu 1709 

Book  XX    Latin-English  Dictionary  of  Drugs 1713 


LIST  OF  ILLUSTRATIONS 


PAGE. 

Abdominal  Binder    1144 

Aconite.      (Colored  Plate) 1423 

Acromio-Clavicular  and  Shoulder  Joints 88 

Ague  Root.     (Colored  Plate) 1405 

Air  Passages  of  the  Lungs 184 

Alimentary  Canal  from  Throat  to  Anus 101,  216 

Ankle  Joint,  Section  of •  88 

Anterior  Splint  for  Fracture  of  Arm 872 

Apple.      (Colored   Plate) 1395 

Application  of  a  Bandage   805 

Applying  the  Diaper 1144 

Arm  Bones S3,  84 

Arteries,   The    511 

Artery  of  the  Arm Ill,  793 

Artificial   Respiration — Mechanical    856 

Artificial  Respiration — Schafer   System    853 

Asparagus.     (Colored  Plates) 1398,  1415 

Atlas  or  First  Cervical  Vertebrae 80 

Balancing  and  Stretching  Exercise 1G84 

Bandage  for  Burn  on  Arm 873 

for  the  Eye 873 

to  Fix  Shoulders  Back 873 

for  Fractured  Collar  Bone • 873 

for  Fractured  Knee-Cap 873 

for  the  Head 873 

for  Lower  Part  of  Leg 873 

for    Mouth-breathing    1643 

for  Outstanding  Ears 1643 

Barberry.      (Colored  Plate) 1433 

Base  of  Brain,  Sectional  View  of 117 

Bathing  the  Infant 1150 

Beet.    "(Colored  Plate) 1399 

Belladonna.     (Colored  Plate) 1429 

Bilberry.     (Colored  Plate) . 1439 

Bitter-sweet  Nightshade.     (Colored  Plate) 1435 

vii 


PIU  '  LIST   OF   ILLUSTRATIONS. 

PAGE. 

Blackberry.     (Colored  Plate) 1427 

Black  Briony.      (Colored  Plate) 1437 

Blood  Corpuscles,  ilagnified   105 

Board  as  Splint  for  Fracture  Below  tlie  Knee 873 

Bone  Fractures   ■ 806 

Bone,  Section  of 75 

Bones  of  Forearm  Acting  as  Levers 744 

Bones  of  the  Hand  (Carpus) 84 

Brain,   The    407 

Brain  and  Cord 121 

Breast   Bandages    878 

Broomstick  Exercise 1685 

Brushing  the  Hair 1643 

Brushing  the  Teeth   1643 

Burrow  (if  Itch  Insect ■ 729 

Buttock  and  Back  of  Thigh 124 

Calaraint.      (Colored  Plate) 1413 

Calcified  Trichina;   751 

Carawav.     (Colored  Plate) 1435 

Carrot.      (Colored  Plate) 1425 

Cartilage,  Section  of   76 

Cathartic.      (Colored    Plate) 1425 

Cathartic  Ramno.     (Colored  Plate) 1409 

Celery.      (Colored  Plate) 1402 

Cells  of  Human  Organism 210 

Cervical  Cord,  Section  of 122 

Chamomile.     (Colored  Plate) 1435 

Changing  Sheets 998 

Character  Lines  of  the  Hand 1C17 

Chart. — Hours  of  Feeding 1145 

Chart.— Hours  of  Sleep    1145 

Checking  Hemorrhage  in  Hand  or  Wrist 794 

Chicken-pox.     (Colored  Plate) 766 

Chittim  Bark.      (Colored  Plate) 1405 

Cholera  Germ   328 

Cholera  Germs.     (Colored  Plate) 238 

Cigar-box  Splint  Applied  to  Fracture  of  Ankle 872 

Ciliated  Epithelial  Tissue 74 

Circulation  in  Frog's  Foot   220 

Cleansing  Breath    1696 


LIST  OF  ILLUSTRATIONS.  IX 

PAGE. 

Coat  Sleeve  Sling 87iJ 

Cold  Compress   16-12 

Colt's  Foot.      (Colored  Plate) 1110 

Common  Bramble.     (Colored  Plate) 11:27 

Common  Hedge  Nettle.     (Colored  Plate) 1107 

Comparison  of  Breast-fed  and  Bottle-fed  Infants 1115 

Constituents  of  Foods 227 

Correct  Position  for  Complete  Breathing 169C 

Course  of  Femoral  Artery 795 

Cross-section  of  Head 1308 

Crow-Foot.      (Colored  Plate) 1131 

Crystalline    Lens    454 

Currants.      (Colored  Plate) 1419 

Curvature  of  Lens •  .  .  4GG 

Daily  Eecord    1021 

Dandelion.      (Colored  Plate) '. 1427 

Dental  Caries.      (Colored  Plate) 1318 

Dental  Floss   1643 

Diagnosis   Charts    91G 

Diagram  of  Both  Circulations 222 

Diagram  of  Circulation 221 

Digestive  System 1302 

Digitalis.      (Colored   Plate) 1431 

Dill.     (Colored  Plate) 1437 

Diseases  of  the  Teeth.     (Colored  Plate) 1300 

Dislocation  of  Lower  Jaw   800 

Dissection  of  Front  of  Forearm Ill,  123 

Dorsal  Vertebrae 79 

Double  Handkerchief  Sling 872 

Dressing  for  Broken  Leg 808 

Drying  the  Face 1642 

Ear,   Section  of 472 

Ear,   The    474 

Eczema.      (Colored   Plate) 714 

Effect  of  Alcohol  on  the  Stomach  and  Intestines.     (Colored  Plate)  1480 

Elder.      (Colored  Plate) 1433 

Electric  Battery  Treatment 1589 

Emergency  Splint  for  Ankle  IMade  from  Cigar-box 872 

Emergency  Splint  for  Fracture  of  Knee-Cap 872 


X  UBT  OF  ILLUSTRATIONS. 

PAGE. 

Encysted  TrichiniB 74:7 

Epithelial    Tissue    74 

Epithelium,  Columnar 74 

Example  of  Physical  Development   1650 

Exercise  for  tlie  Abdomen 1G74 

for  Abdomen  and  Trunk   1074 

for  Abdominal  Muscles   1658 

for  the  Back 1056,  1074 

for  the  Bust   • 1674 

with  Chair 1684 

for  the  Chest 1674 

for  Constipation   1674 

for  Female  Weakness 1674 

for  Grace  and  Agility 1074 

for  the  Hips   1674 

for  Muscles  of  the  Front  of  the  Body 1658 

for  Prolapsed  Organs 1675 

for  the  Spine • .  .  .  .  1G56 

for  the  Stomach  and  Abdomen 1658 

for  the  Trunk  of  the  Body ,  .  1658 

with  Two  Chairs 1684 

Eye,  Section  of 452 

Eye,  The 461 

Face,  Nerves  of 118 

Fat,  Section  of 76 

Femur,  or  Thigh  Bone 87 

Fennel.      (Colored  Plate) 1409 

Fibula,  or  Minor  Shin  Bone 87 

Filling  Upper  Lobe  of  Eight  Lung 1696 

Flax.     (Colored  Plate) 1425 

Flesh  Brush    • 1642 

Folding  the  Diaper   1144 

Folds  of  the  Intestines 218 

Foot  Bones   87 

Four-tailed  Bandage  for  the  Chin 876 

Foxglove.      (Colored  Plate) 1431 

Fracture  of  Both  Bones  of  Forearm 807 

Fracture  of  Humerus    808 

Front  and  Side  Views  of  the  Teeth  and  Jaws 1307 


LIST  OF  ILLUSTRATIONS.  XI 

PAGE. 

Garlic.     (Colored  Plate) 1417 

General  Exercises  for  Women 1674 

Geranium.     (Colored  Plate) 1435 

Glandular  Epithelium   74 

Golden  Thistle.      (Colored  Plate) 1411 

Grape.     (Colored  Plate) 1397 

Grape-Fi-uit.      (Colored   Plate) 1395 

Great  Mullein.     (Colored  Plate) 1429 

Hand  Bandages    875 

Hand  Wrestling • .  .  1C85 

Head,  Arteries  of 109 

Head  Bandage   872 

Heart,  The   499 

Heart  and  Lungs,  Sectional  View 106 

Heart  Cavities,  Eight  Side 502 

Heart,  Showing  Arteries.     (Colored  Plate) 504 

Heart,  Showing  Auricles  and  Ventricles 107 

Hedge  Mustard.     (Colored  Plate) 1407 

Hedgewort.     (Colored  Plate) 1439 

Hellebore.     (Colored  Plate) 1421 

Hemlock.     (Colored  Plate) 1433 

Henbane.     (Colored  Plate) 1413 

Hip  Joint,  Socket  and  Ligaments 88 

Home  Tests  for  Urine.     (Colored  Plate) G34 

Hookworms    310 

Hops.     (Colored  Plate) 1415 

Horse  Chestnut.     (Colored  Plate) 1425 

Horse-Eadish.     (Colored  Plate) 1417 

How  to  Stop  Bleeding 846 

How  to  Stop  Bleeding.     (Colored  Plate) 848 

Human  Milk  Containing  Colostrum  Corpuscles 228 

Human  Skeleton.      (Colored  Plate) 736 

Human  Skeleton.     (Full  Page) 78 

Humerus    83 

Ideal    Sick   Eoom 999 

Ice  As  a  Cosmetic 1642 

Infant  Bathing  Table 1144 

Internal  Organs.      (Colored  Plate) 504 

Iris.     (Colored  Plate) 1427 

Itch  Insect 728 


XJl  UST  OF  ILLUSTEATIONS. 

PAGB. 

Japanese  Ladies   1558 

Juniper.      (Colored  Plate) lilO 

Kidney  Disease.     (Colored  Plate) 590 

Lacteals  and  Lymphatics 219 

Laurel.      (Colored  Plate) 1-137 

Leg,    Arteries   of    112 

Leg,  Front  View  of   124 

Lemon,  The.     (Colored  Plate) 1394 

Licorice.      (Colored  Plate) 1127 

Lily  of  the  Valley.     (Colored  Plate) 1423 

Linie-Tree.      (Colored  Plate) 1411 

Liver  Complaint.     (Colored  Plate) 590 

Liver,  Section  of.     (Colored  Plate) 504 

Liver,  Showing  Lobes  and  Bile  Lhict 103 

Lousewort.      (Colored  Plate) 1411 

Lumbar  Vertebrae 79 

Lungs   lOG,   183 

Lungs  and  Their  Diseases 535 

Lungs.     (Colored  Plate) •  504 

Lying-in  Room    1144 

L^Tuphatics    103,    104 

Mammary  Gland    691 

Manikin  of  the  Body.     (Colored  Plate) 40 

Manikin  of  the  Eye,  Ear,  Hand,  Foot  and  Leg.     (Colored  Plates)  60 

iLanikiu  of  the  Ilead.     (Colored  Plate) 36 

Marshmallow.      (Colored  Plate) 1415 

Massage  of  the  Body 1642 

for  the  Bust   1643 

for  Double  Chin 1643 

for  the  Eyes • 1642 

for  the  Face   1643 

of  the  Scalp 1643 

for  Wrinkles   1643 

Meadow  Saffron.      (Colored  Plate) 1417 

Ifeasles.      (Colored  Plate) 760 

Mezereon.     (Colored  Plate) 1437 

Mountain  Balm.     (Colored  Plate) 1413 

Muscles  of  the  Back 92 

Back  of  Thigh   97 


LIST  OF  ILLUSTKATIONS.  XIU 

PAGE. 

of  the  Body,  Back  View 89 

of  the  Body,  Front  View 90 

of  the  Chest 93 

of  Face,  Jaw  and  Neck 91 

of  Forearm    94 

of  Front  of  the  Leg 97 

of  the  Larynx 529 

Muscular  System.      (Colored  Plate) 752 

Mustard.     (Colored  Plate) 1413 

Neck,  Arteries  of 110 

Kerve  Cells 76 

Fifth    119 

Vitaliziug  Breath   1G9G 

Nerves,   The    125 

of  the  Face  and  Scalp 118 

Leading  to  Roots  of  the  Teeth 1324 

Magnified 77 

Ninth,  Tenth  and  Eleventh 120 

of  the  Side  of  the  Face 441 

of  the  Thigh 96,  123 

Nettle.     (Colored  Plate) •  1429 

Non-striated  Muscle   77 

Normal  and  Pinched  Nerves 1524 

Nursing  Chart   1020 

Nutritive  Proportions  of  Foods 224 

Oak-Tree.     (Colored  Plate) 1433 

Onion.     (Colored  Plate) 1400 

Operation  for  Cataract 464 

Oregon  Wild  Grape.     (Colored  Plato) 1396 

Ovary  and  Mammary  Gland   691 

Parsley.     (Colored  Plate) 1431 

Pavement  Epithelial  Tissue 74 

Pelvis  of  the  Male 86 

Pennyroyal.      (Colored  Plate) 1421 

Peony.      (Colored   Plate) 1423 

Peppermint.      (Colored  Plate) 1437 

Perforated  St.  John's  Wort.     (Colored  Plate) 1423 

Peritoneum,  Showing  Involved  Organs   102 

Periwinkle.     (Colored  Plate) 1439 

Permanent  Teeth  of  Right  Side 1306 


XIV  LIST   OF   ILLUSTRATIONS. 

PAGE. 

Plantain.     (Colored  Plate) 1421 

Poppy.     (Colored  Plate) • 1421 

Position  for  Bottle-Feeding 1161 

Position  for  Breast-Feeding , 1145 

Positions  of  the  Vocal  Cords 528 

Posterior  Splint  for  Fracture  of  Arm 872 

Prevention  of  Wrinkles 1642 

Properly  JMade  Bed 999 

Proportions  of  Healtbj  Child's  Body 1145 

Pulmotor    856 

Pumpkin.     (Colored  Plate) 1400 

Pyorrhoea   Alveolaris    1322 

Quieting  the  Baby 1161 

Racemose  Gland 74 

Radius    • 84 

Recurrent  Bandage    874 

Red  and  \Miite  Blood  Corpuscles 223 

Red-berried  Trailing  Arbutus.     (Colored  Plate) 1411 

Red  Pepper.     (Colored  Plate) 1403 

Removing  Blackheads 1642 

Removing  Superfluous  Hair 1642 

Rescue  from  Drowning 853 

Ribs  Showing  Thorax 82 

Rigg's  Disease 1322 

Right  and  Wrong  Ways  of  Holding  Baby 1160 

Ringworm  on  the  Hair 723 

Rolier  Bandage 873 

Rooster  Fight   1685 

Rosemary.     (Colored  Plate) 1429 

Saffron. '  (Colored  Plate) 1407 

Sage.     (Colored  Plate) 1413 

Salivary  Gland   98 

Salvia.      (Colored   Plate) 1413 

Santal  Wood.     (Colored  Plate) 1405 

Scald  Head.     (Colored  Plate) 715 

Scalp,  Nerves  of 118 

Scapula  or  Back  of  Shoulder 83 

Scarlatina       (Colored  Plate) 761 

Scarlet  Fever.     (Colored  Plate) 761 

Scurvy-Grass,     (Colored  Plate) 1417 


LIST   OF   ILLUSTRATIONS.  XV 

PASS. 

Sebaceous  Glaud,  Magnified 721 

Semilimar  Valves  of  the  Heart 108 

Shoulder  Joints -  . .  • 88 

Simple  Baudage  for  Foot  aud  Ankle 873 

Simple  Gland   74 

Simple  Spiral  Baudage S72 

Simple  Spiral  Baudage  over  Splint 872 

Skin,  The   712 

Skull,  Front  View  of 81 

Small-pox,  Confluent  or  Enmassed  Form.     (Colored  Plate j 260 

Small-pox,  Discrete  or  Separate  Form.     (Colored  Plate) 200 

Spinal  Column   7{) 

Spinal   Cord    ■ 121 

Spinal  Foramina 1524 

Spiral  Reverse  Bandage 872 

Stavesacre.      (Colored  Plate) 1411 

Stimulating  the  Hair  Roots 1643 

Stomach,  The 100 

Stomach.     (Colored  Plate) f)04 

Stomach  Tubule   lOO 

Stone  Root.     (Colored  Plate) 1405 

Straw  Lily.     (Colored  Plate) 1427 

Striated  Muscle 77 

Swallowing  Muscles   215 

Tansy.     (Colored  Plate) 1409 

Teeth  of  Child  Between  Six  and  Seven  Years  of  Age 1308 

Teething  Chart 1163 

Temperature  Chart 1022 

Temporary  Teeth  in  Child  Aged  About  Four  Years 1311 

Temporary  Teeth  of  Left  Side 1305 

Temporary  Teeth  of  Right  .Side 1305 

Test  for  Rubber  Xipplcs 1151 

Thigh,  Arteries  of ■ 112 

Thigh,  Back  View  of 124 

Thorax,  The 82,  116 

Thorn-Apple.      (Colored  Plate) 1415 

Tibia  or  Shin  Bone    87 

Tomato.     (Colored  Plate) • 1401 

Tongue.     (Colored  Plate) 918 

Tongue,  The , 99,  663 


^71  LIST  OF  ILLUSTRATIONS. 

PAGE. 

To  Prevent  Infant  from  Taking  Your  Cold 1145 

Transportation  of  tlie  Injured 856 

Treatment  of  the  Eyelashes 1642 

Treatment  for  Moles 1642 

Triangular  Bandage  As  a  Sling   873,  877 

Triangular  Bandage  for  the  Head   876 

Triangular  Bandage  for  the  Foot 873 

Trichina  and  its  Cyst   750 

Cyst    ". 749 

in  Human  Muscle.     (Colored  Plate) 238 

Spiralis  in  Human  Muscles 746 

Tuberculosis  Bacillus.     (Colored  Plate) 238 

Ulcerative  Stomatitis   1322 

Ulna,  or  Bone  of  the  Forearm 84 

Umbrella  As  Splint  for  Fracture  Below  the  Kneo 873 

Urinary  and  Generative  Organs  of  Women G40 

Urinometer,  The 634 

Vaccination.     (Colored  Plate) 271 

Vaccination  As  a  Preventive  of  Small-pox 268 

Valerian.      (Colored  Plate) 1431 

Valves  of  the  Heart 516 

Varioloid.     (Colored  Plate) 267 

Veins  of  the  Leg 114 

Veins  of  the  Upper  Extremity 114 

Villi  of  the  Small  Intestine 218 

Vincent's  Angina    1322 

Vocal  Apparatus 527 

Vocal  Cords 528 

Washing  the  Face   1642 

What  to  Do  if  Bitten  by  a  Mad  Dog  or  Poisonous  Eejjtile.  (Colored 

Plate) .• 828 

AMiite  TToarhound.     (Colored  Plate) 1419 

Wild  Strawberrv.      (Colored  Plate) 1439 

Wolf's  Bane.     (Colored  Plate) 1423 

Wood  Sorrel.     (Colored  Plate) 1409 

Wormwood.      (Colored   Plate) 1425 

Wrestling 1685 

X-Eay  Photograph   1588 

Yellow  Fever  Mosquito 295 

YeUow  Goat's  Beard.     (Colored  Plate) 1407 


INDEX  TO  BOOK  I 


Book  I  describes  tlie  human  body  and  illustrates 
it  by  a  series  of  Manikins  or  Anatomical  Charts. 

The  following  list  of  contents,  alphabetically 
arranged,  will  enable  the  reader  to  quickly  turn  to 
any  subject  or  illustration  desired : 

SUBJECTS  OF  THE  TEXT 


Abdomen,  Walls  of 

Appendix,   Vermiform    

Arms,  Blood  Supply  of 

Arms,  Bones  of 

Arteries,  The 

Bladder,  The   56, 

Blood,  Coagulation  of  

Blood,  Description  of   

Blood  Supply  of  Arm  

Blood  Supply  and  Muscular  Arrange- 
ment      

Blood-vessels  of  the  Body   

Blood-vessels  of  the  Liver   

Body,  Muscles  of  

Body,  Structure  of  

Bones  of  the  Face 

Bones  of  the  Skull  

Bones  of  the  Spinal  Column 

Bones  of  the  Thigh  and  Leg 

Bones  of  the  Trunk  and  Arms 

Brain,  Base  of  

Brain  Cavity 

Brain,  Consistency  of  

Brain,  Location  of  

Brain,  Mechanism  of  

Brain,  Sectional  View  of 

Brain,  Shape  of  

Brain,  Vertical  Section  of 

Breathing    

Cerebellum    

Cerebrum   

Chest,  Composition  of  

Child,  Position  of  at  Birth   

Clitoris,  The   

Coagulation  of  the  Blood  


33 


Cranium,  Base  of  , 37 

Deftness  of  the  Fingers   66 

Development,  Muscular   66 

Digestive  Apparatus,  Description  of...   51 

Ear,  Description  of  59 

Ear  Drum,  The  60 

Eye,   Description  of   59 

Eye,  Muscles  of 59 

Eye,  View  of 36 

Face,  Bones  of 40 

Face,  Muscles  of 35 

Fingers,  Deftness  of 66 

Foot,  Description  of   62 

Good  Health,  Picture  of  35 

Hand,  Description  of   60 

Heart,  Description  of 48 

Hymen,  The  56 

Intestines,  The  53 

Kidneys,  The   58 

Knee- Pan    (Knee^Cap)     64 

Leg,  Bones  of  64 

Leg,  Description  of 63 

Leg,  Muscles  of  6^,  65 

Liver,   The    52 

Liver,  Blood-vessels  of   53 

Lungs,  The  45 

Lungs,  Breathing  Capacity  of   47 

Lungs,   Description  of   -15.46 

Lungs,  Pleura  of 45 

Mucles  of  the  Body  43 

Muscles  of  the  Eye 59 

Muscles  of  the  Face 35 

JNIuscIes  of  the  Leg 63,  65 

Muscles  of  the  Neck 35,  36 

Muscles  of  the  Shoulder  43 


84 


INny.X   TO   BOOK  I. 


Muscles  of  the  Thigh  65 

Muscular     Arrangement     and     Blood 

Supply    42 

Muscular  Development   66 

Neck-,  Muscles  of  35,  36 

Nerve,   Sciatic   64 

Nose,  The   38 

Olfactory  Nerve  38 

Ovaries   56 

Pancreas,  The    53 

Pelvis,  The  44 

Picture  of  Good  Health  35 

Position  of  Child  at  Birth $7 

Pylorus,   The    52 

Respiration     47 

Ribs,   The    44 

Sciatic  Nerve,  The  64 

Shoulder  Joints,  The  44 


Shoulder,  Muscles  of   43 

Skull,  Bones  of  39 

Skull,  Shape  of  39 

Spinal   Column    40,  44 

Spinal  Column,  Bones  of 44 

Spleen,  The  58 

Stomach,  The  52 

Thigh  Bones   64 

Thorax,    The    42 

Toes,   The    62 

Tongue,  The  38 

■  Trunk,  Bones  of  43 

Urethra,   The    56 

Vagina,  The   56 

Veins,   The    58 

Vermiform   Appendix    55 

Voice,   The    66 

Womb,   The    > 56 


LIST  OF  ILLUSTRATIONS 


Body,  Manikin  of  40 

Ear,  "  "  60 

Eye,  "  "  60 

Foot,  "  "  60 


Hand,  JIanikin  of    60 

Head,         "  "    .-  •  ■  36 

Leg,  "  "    60 


Book    I. 

THE    HUMAN    BODY. 


A  Description  of  the  Colored  Anatomical  Cluirts  Composing  the  Manikin 
Accompanying  this  WorJc. 

CHART   I. 

A  PICTUEE  OF  GOOD  HEALTH. 

This  exquisitely  beantifnl  and  artistic  Anatomical  Plate  presents  the 
head  and  face  of  a  young  man  in  the  enjoyment  of  perfect  health.  Apart 
from  the  subject  it  so  accurately  and  faithfully  represents,  it  is  in  itself  a 
valuable  life-like  portraiture  of  the  human  head  and  face,  and  shows  to 
what  perfection  the  art  of  anatomical  plate  printing  has  attained.  Note 
the  prominent  perceptive  faculties,  the  high  forehead,  features  character- 
istic of  a  large  brain  and  a  massive  and  imimpaired  intellect.  Mark  the 
open  expression  of  the  eye !  how  true  to  nature  and  life-like.  Observe  the 
compressed  lips,  denoting  firmness  of  character  and  determination  of 
puri^ose.  Look  attentively  at  the  bright,  open,  manly  countenance;  there 
are  no  signs  of  mental  decrepitude,  physical  bodily  iiafirmities,  nervous 
fear,  or  exhaustion  of  brain  power  or  life-force  in  the  expression  of  the 
noble,  ruddy  and  healthy  face.  It  is,  as  its  name  im^jlies,  typical  of  Per- 
fect Health! 

Muscles  of  the  Face  and  Neck — This  fine  plate  is  a  remarkalily  real- 
istic and  accurate  representation  of  the  head  and  neck,  after  the  outer 
skin  has  been  removed.  It  shows  the  bare  skull,  together  with  the  ad- 
mirable and  skilful  arrangement  of  the  muscles  of  the  face  and  neck ;  also 
the  external  part  of  the  ear.  There  are,  also,  numerous  blood-vessels 
noticed  meandering  over  the  parts  exposed  to  view,  by  means  of  which 
this  muscular  area  receives  its  supply  of  nutrient  blood.  The  large,  broad 
muscle  observed  over  the  forehead  is  the  one  by  which  we  elevate  the 
brow,  and  in  conjunction  with  the  orbicular  muscle  that  is  seen  surround- 
ing the  eye,  we  can  contract  the  brow,  as  in  "scowling." 

Muscles  of  the  Face — The  muscles  of  the  face  are  those  employed  to 
give  variety  of  expression  to  the  countenance     It  is  through  the  medium 

(35) 


36  TnF,  nnwAN  nonT. 

of  these  small  hut  nspfnl  imisclcs  tlmt  puhlic  speakers  can  give  facial 
emphasis  to  their  ilow  of  rhetorical  eloquence;  the  tragedian  employs 
them  to  give  dramatic  cilcct  to  the  various  characters  he  impersonates, 
and  the  low  comedian  and  "clown"  cultivate  them  for  facial  contortion 
and  "guying"  characterization.  The  numerous  muscles  observed  about 
the  neck  are  those  which  give  elasticity  and  mobility  to  the  head.  It  ia 
by  means  of  these  muscles  that  the  head  can  rotate  on  its  axis,  bend  for- 
ward, backward,  sidewise,  and  pose  in  the  diversified  attitudes  and  various 
positions  it  can  be  made  to  assume. 

THE  BRAIN;  AND  A  VERTICAL  SECTION  OF  THE  FACE  AND  NECK. 

"What  the  Plate  Shows. — As  we  progress  in  our  anatomical  course  of 
study,  our  attention  is  firmly  and  deeply'  fixed  in  wonder  and  amazement 
at  the  marvelous  mechanism  revealed  in  the  sublime  profundity  and 
grande^ir  brought  out  in  this  magnificent  artistic  plate.  It  brings  before 
our  astonished  vision  the  beautiful  proportions  and  symmetry  of  the 
human  brain  as  it  lays  in  situ  within  its  bony  castle ;  and  as  we  look  upon 
its  wavy  convolutions  we  naturally  turn  our  thoughts  to  the  hidden  mys- 
teries of  mind  and  to  its  superiority  over  matter,  and  to  the  illimitable 
intelloctual  properties,  powers  and  capacity  of  the  mind,  that  lay  quietly 
slumbering  in  the  depths  of  the  human  brain,  for  the  mind  of  man  sur- 
passeth  all  things  of  human  conception  or  construction.  Below  this  mighty 
throne  of  reason  and  intelligence,  on  the  left,  we  observe  the  cerebellum 
or  lesser  brain,  the  fount  from  whence  all  the  vegetative  or  organic  func- 
tions of  life — as  respiration,  beating  of  the  heart,  digestion,  etc. — receive 
their  inspiration  and  supply  of  vital  force. 

View  of  the  Eye. — ^We  can  likewise  view  the  human  eye  as  it  lays  in 
position  in  its  bony  socket,  and  wonder  at  our  Creator's  munificence  and 
benevolence  in  providing  us  with  such  a  delicate  instrument  of  vision  with 
which  to  light  our  way  about  in  the  world,  and  view  the  magnificent  beau- 
tics  of  nature  that  surround  us  on  every  hand.  Here,  too,  we  observe  the 
teeth,  those  essential  pre-requisitcs  to  personal  beauty,  and  valuable  ad- 
juncts to  the  powers  of  articulation  and  speech,  protruding  through  the 
gums,  their  roots  being  visible  above  and  below  the  gums;  and  in  the 
lower  set  we  see  the  dental  nerve  distributing  its  nervous  supply  to  their 
individual  and  collective  roots. 

The  Neck  Muscles. — This  beautiful  illustration  brings  out  in  bold  re- 
lief the  superficial  and  deep  muscles  of  the  neck,  and,  at  the  same  time, 
we  observe  a  faithful  delineation,  not  only  of  the  relative  position  of  the 


CHART    1 


"I. 


COPYRIGHT 


ISIC   BY  E .  J . STANLEY 


CHART    1  . 


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VIEW  OF   BASE   OF  BRAIN   SHOWING  THE  ORIGIN   OF    THE 

NERVES    OF    SPECIAL    SENSES    AND    BLOOD 

SUPPLY    OF    BRAIN 


CHART     1  . 


SECTIONAL  VIEW  OF  THE  BEAIN,  FACE  AND  THEOAT.  Si 

carotid  artery  and  jugular  vein,  but  also  of  the  manner  in  which  the  mus- 
cular and  fleshy  part  of  the  neck  receives  its  nervous  supply. 

VIEW  OF  THE  BASE  OF  THE  CRANIUM. 

Brain  Cavity. — Here  in  this  remarkable  illustration  we  have  pre- 
sented to  us  one  of  the  most  wonderful  views  in  the  anatomy  of  the  skull, 
or,  in  fact,  of  any  part  of  the  human  frame.  It  is  a  view  of  the  floor  of 
the  cranial  cavity  on  which  that  curious  and  mysterious,  but  sublime 
organ,  the  brain,  rests.  The  marvelous  skill  and  ingenuity  therein  dis- 
played, of  the  complex  mechanism  surveyed,  the  beautiful  and  intricate 
manner  in  which  the  nerves  of  special  sense  are  so  elaborately  set  forth, 
the  complicated  profusion  and  exquisite  design  manifest  in  the  distribu- 
tion of  blood-vessels  for  the  nourishment  and  support  of  the  special  organ 
of  reason  and  intelligence — all  claim  our  closest  and  undivided  attention, 
and  we  are  unconsciously  led  to  revere  the  Omniscience  of  Him  who 
could  conceive  of  such  intricate  architecture,  and  perform  such  delicate, 
unique  and  perfect  workmanship.  The  large  opening  observed  in  the 
floor  of  the  cranial  cavity  is  the  foramen  magnum,  through  which  the 
spinal  cord,  together  with  the  cerebro-spinal  nerves,  escape. 

SECTIONAL  VIEW  OF  THE  BRAIN,  FACE  AND  THROAT. 

The  Brain  in  its  Bony  Citadel. — The  artist,  with  true  anatomical  in- 
stinct and  a  rare  technical  ability  in  regard  to  accuracy  and  minute  detail, 
has  performed  his  part  of  the  work  in  this  illustration  with  such  faithful 
fidelity  to  nature  that  one  camiot  withhold  a  word  of  praise  at  the 
grand  style  and  elaborate  manner  of  its  execution.  This  elegant  and 
artistic  anatomical  plate  represents  the  brain  held  firmly  in  position  within 
its  strong,  bony  citadel,  but  cleft  in  twain  from  above  downward,  thus 
showing  its  internal  mechanism  and  construction;  besides  which  it  gives 
the  internal  arrangements  of  the  nose,  tongue,  throat  and  neck. 

Order  of  Brain  Mechanism — Commencing  from  above  and  descending 
downward  we  observe  the  following  important  structures,  to  wit:  The 
fascia  or  skin  covering  the  cranial  bones ;  and  then  a  section  of  the  bones 
themselves,  showing  their  laminated  structures.  Between  the  bones  of 
the  skidl  and  the  brain  are  seen  the  meningeal  coats  of  the  brain,  which 
serve  the  double  purpose  of  supplying  it  with  blood-vessels  and  protecting 
that  delicate  organ  from  pressure  or  injury. 

Cerebrum  and  Cerebellum — We  observe  that  the  cerebrum,  the  seat 
of  mind  and  volition,  is  much  larger  than  the  cerebellum  or  little  brain ; 


38  THE    nUMAN    BODT. 

and  as  though  that  was  not  enough  area  for  the  evolution  of  the  mind, 
we  see  this  part  of  the  brain  most  curiously  wrinkled  and  folded  into 
various  sized  convolutions,  thus  increasing  the  mental  surface.  The  more 
niiiiierous  these  convolutions  arc,  the  higher  and  more  noble  the  mental 
faculties  and  intellectual  powers  become.  The  hemisphere  of  the  brain, 
here  shown,  is  seen  to  be  divided  into  three  lobes,  the  frontal,  middle  and 
posterior.  The  Corpus  Callosum,  or  the  great  commissure  of  the  brain, 
is  most  faitlifullj  represented,  and  immediately  below  is  seen  the  Fornix. 
The  peculiar  apjiearance  of  the  cerebellum  or  little  brain  presents  a  tree- 
like resemblance,  whence  it  is  called  tlie  arhor  vitcv,  or  the  tree  of  life.     . 

The  Olfactory  Nerve. — The  olfactory  nerve  is  graphically  displayed, 
branches  of  which  are  seen  passing  in  all  directions  over  the  mucous  mem- 
brane of  the  nose.  A  little  to  tlie  left  of  the  olfactory  nerve  is  seen  the 
posterior  nares,  and  immediately  below  tlic  pharynx  and  epiglottis,  the 
cosophairus  or  gullet,  tlie  lar_\Tix  and  trachea  or  wind-pipe. 

The  Tongue. — The  tongue,  or  organ  of  taste  and  instrument  of  speech, 
is  most  accurately  represented,  the  muscular  fibres  of  which  are  seen 
running  in  diflferent  but  determinate  ways,  thus  giving  to  this  important 
organ  variety  and  regularity  of  motion  and  aiding  it  to  assume  numerous 
shapes  and  forms.  The  cervical  portion  of  the  spinal  column  is  seen,  with 
the  fleshy  part  of  the  back  of  the  neck  attached.  This  plate  is  one  that 
commends  itself  to  our  deep  and  careful  study. 

VIEW   or   THE   BASE    OF   THE   BRAIN,    AND    THE    THOUGHTS    IT 

SUGGESTS. 

Shape  of  Brain.^As  so  graphically  delineated  in  this  beautifid  as 
well  as  natural  illustration  of  the  human  brain,  we  glean  a  knowledge 
of  the  origin  and  source  of  its  blood  supply;  the  arteries  are  observed  to 
distribute  numerous  branches  in  various  directions  along  and  over  its  sur- 
face, many  of  which  penetrate  its  substance.  As  noticed,  the  brain  pre- 
sents an  ovoid  or  egg-shaped  appearance,  divided  into  two  equal,  lateral 
halves — hemispheres  as  they  are  called — thus  virtually  giving  us  two 
brains,  the  same  as  we  have  two  eyes,  two  arms  and  two  legs.  Witli  this 
surplus  of  brains,  as  it  were,  at  our  command,  we  are  naturally  led  to  ask 
the  question,  who  can  define  the  metes  and  boimds  of  the  mind  ?  Or  de- 
scribe the  limits  of  our  intellectual  capacity  ?  Who  can  fathom  the  depths 
of  thouglit?  Or  circumscribe  our  mental,  educational  or  scientifical  ac- 
quirements, when  health  crowns  the  human  temple  with  its  rubicimd 
mantle?    Echo  answers  who! 

Seaaty  of  the  Brain  Views. — Every  view  of  the  human  train  we  have 


BOTiTES  OF  THE  HEAD,  FACE  ANT>  NECK.  39 

eeen  in  this  series  of  magnificent  and  unparalleled  anatomical  plates  has 
inspired  onr  admiration  and  held  us  spell-bound  in  utter  astonishment  and 
amazement  at  the  limitless  attributes,  the  diversified  powers,  and  the 
variety  of  functions  this  wondrous  and  mysterious  organ  is  called  upon 
to  perform  in  the  hourly  transaction  and  business  pursuits  of  daily 
human  life.  And  yet,  notwithstanding  the  marvelous  properties  of  this 
elaborate  organ,  it  is  the  least  solid  and  most  unsubstantial  looking  body 
of  the  human  casket. 

Consistency  of  the  Brain. — It  consists  of  eighty  per  cent,  of  water, 
seven  per  cent,  of  albumen,  some  phosphorized  fat  and  a  few  other  minor 
substances.  Such  is  the  composition  of  the  mighty  and  powerful  organ 
which  rules  the  world.  Whilst  the  brain  is  the  seat  of  sensation,  yet  it 
can  be  cut,  burned  or  electrified  without  causing  pain  in  itself.  Strange, 
passing  strange,  are  the  properties  and  powers  of  the  brain! 

BONES  OF  THE  HEAD,  FACE  AND  NECK. 

Bones  of  the  Skull. — This  illustration  gives  an  accurate  and  faithful 
representation  of  the  head,  face  and  neck,  surrounded  by  an  outline  of 
the  fleshy  parts  as  they  appear  in  the  human  frame.  The  bones  of  the 
head,  eight  in  number,  constitute  the  skull,  and  those  of  the  face,  four- 
teen in  number,  compose  a  strong,  hard  bony  case,  which  encloses  and 
afl'ords  a  suitable  protection  for  the. brain  and  the  four  organs  of  special 
sense,  viz.:  sight,  smell,  taste  and  hearing.  All  of  these  bones  are  im- 
movable, except  the  lower  jaw,  which  moves  by  means  of  a  hinge-joint, 
and  permits  of  the  opening  and  closing  of  the  mouth. 

Bones  Seen  in  the  Plate — The  bones  of  the  skull  observed  in  this 
beautiful  plate  are:  the  frontal,  which  forms  the  forehead  or  front  part 
of  the  skull;  the  parietal,  constituting  a  portion  of  the  side  and  top  of 
the  head ;  the  occipital,  forming  the  lower  and  back  part  of  the  skull,  and 
the  temporal,  which  forms  the  lower  part  of  the  side  and  a  part  of  the 
base  of  the  cranium.  These  several  bones  are  joined  together  by  notched 
seams,  after  the  manner  carpenters  call  "dove-tailing." 

Shape  of  the  Skull. — The  skull,  as  will  be  seen,  is  oval,  which  adapts 
it  to  the  conformation  of  the  brain,  besides  giving  it  greater  resistance  to 
pressure.  The  stronger  and  smaller  end  is  in  front,  where  danger  is 
greatest  to  the  brain,  whilst  the  projections  before  and  behind  shield  its 
less  protected  parts.  The  peculiar  confonnation  and  shape  of  the  skull 
forms  a  strong  shelter  for  the  brain — an  organ  so  delicate  that  if  not  so 
strongly  guarded  from  injury,  an  ordinary  blow  falling  upon  it  would 
destroy  it  forever. 


iO  THE    HUMAN    BODT. 

Bones  of  the  Face.- — The  bones  of  tlie  face  shown  in  this  plate  are  the 
nasal  bone,  forming  the  arch  of  the  nose,  the  malar,  which  gives  promi- 
nence to  the  cheek,  the  upper  jaw,  containing  the  upper  teeth,  and  the 
lower  jaw,  containing  the  under  teeth. 

The  Spinal  Column — That  portion  of  the  spinal  column  noticed  in  the 
illustration  consists  of  the  cervical  vertebrae.  Each  vertebra  is  composed 
of  a  body,  with  seven  spinous  processes  projecting  from  it.  The  body  is 
perforated  by  a  ring,  through  which  is  seen  running  the  spinal  cord,  giv- 
ing off  nerves  between  each  separate  bone.  A  ring  of  cartilage  is  seen 
inserted  between  each  separate  vertebra,  the  object  of  which  is  to  prevent 
any  jar  reaching  the  brain  when  we  run,  jump,  walk  or  stumble. 


CHART   II. 
THE  INTERNAL  WONDERS  OF  THE  HUMAN  BODY  REVEALED. 

THE  HUMAN  BODY  AND  ITS  MARVELOUS  PERFECTION. 

Wonderful  Structure  of  the  Body. — The  human  body  is  the  highest 
form  of  animal  life.  It  is  full  of  beautiful  proportions  and  divinely  sym- 
metrical in  shape,  form,  mould  and  outline.  We  look  with  honest  pride 
and  glowing  admiration  upon  the  many  accomplishments  that  man  has 
achieved  in  the  world  around  us.  We  see  his  skill  displayed  in  the  various 
arts  and  sciences,  and  we  look  with  awe  upon  the  projects  of  bis  intellect 
and  reason,  the  realization  of  which  is  but  a  small  question  of  time !  .  We 
boast  of  our  ships,  our  steamboats  and  our  steam  cars ;  we  are  justly  proud 
of  our  bridges,  our  viaducts  and  the  progress  of  our  engineering  skill ;  we 
grow  enthusiastic  over  our  telegi'aphs,  our  telephones,  our  electric  lights; 
we  feel  a  degree  of  national  pride  in  the  achievements  and  successes  of 
Edison,  the  wizard  of  Menlo  Park ;  but  wliere,  let  us  ask,  in  the  whole 
range  of  events,  the  acquirements  of  arts,  the  accomplishments  of  me- 
chanics, the  achievements  of  architecture,  the  attainments  of  engineering, 
or  the  successes  and  promises  of  electrical  sciences,  can  we  find  siich  an- 
other structure  as  the  human  body,  that  curious,  yet  perfect  world  of 
wonders ! 

Man  the  Most  Complex  Body — It  embodies  an  epitome  of  the  whole 
universe !  Man  is  more  elaborate,  more  complex,  more  God-like,  than 
any  other  living  organism ;  more  wonderful,  more  beautiful,  more  mar- 
velous, than  any  work  of  human  ingenuity,  conception  or  construction. 


CHART    2. 


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MAN  THE  MOST  COMPLETE  BODY.  41 

Indeed,  the  mechanism,  the  skill  and  the  workmanship  displayed  in  the 
human  body  is  simply  perfection  itself.  In  conception,  it  is  divine;  in 
design,  perfect ;  in  architecture,  grand ;  in  construction,  wonderful ;  in 
beauty,  lovely;  in  form,  symmetrical;  in  outline,  sublime;  in  strength, 
great ;  in  arrangements,  marvelous ;  in  mobility,  transcendant ;  in  adapt- 
ability, unexcelled ;  in  fine,  when  studied  in  all  its  parts  and  their  rela- 
tionship to  each  other,  we  are  led  to  exclaim  with  the  Psalmist  David, 
that  the  human  body  is  "fearfully  and  wonderfully  made." 

Man  the  Most  Complete  Body — The  all-wise  Creator,  when  He  first 
made  man,  made  him  perfect.  lie  formed  every  organ  of  the  body  with 
direct  reference  to  the  function  to  be  performed.  Every  bone,  muscle, 
nerve,  organ  and  tissue  formed  in  the  constriiction  of  this  wondrous  or- 
ganism is  made  of  the  right  kind  of  material;  is  of  the  proper  form  and 
size ;  placed  in  the  right  position  to  subserve  best  the  purpose  for  which 
they  were  individually  and  collectively  designed,  and  to  perform  the 
peculiar  duties  assigTied  to  each.  We  cannot  talk  with  the  ears,  smell 
•with  the  eyes,  see  with  the  nose,  nor  walk  with  the  tongue.  We  cannot 
think  with  the  lungs,  nor  breathe  with  the  brain.  The  stomach  was  not 
designed  to  propel  the  blood  over  the  system,  nor  the  heart  to  digest  food. 

The  Complete  Organs  and  Structures. — The  muscles  which  give  form 
and  shape  to  the  body  would  be  powerless  instruments  of  movement  if 
devoid  of  the  bones  of  the  skeleton.  Thus  we  see  that  every  organ  and 
structure  was  formed  with  direct  reference  to  the  accomplishment  of  a 
certain  definite  object.  Hence,  the  bones  form  a  frame  work,  to  protect 
the  delicate  organs  of  mind,  respiration,  circulation,  digestion  and  excre- 
tion, to  serve  as  levers  on  which  the  muscles  may  act  to  produce  motion, 
and  to  preserve  the  form  and  shape  of  the  body ;  the  muscles,  such  as  we 
observe  in  this  plate,  give  form,  shape  and  symmetrical  proportions  to 
the  body,  and  produce  its  varied  motions ;  by  means  of  the  brain  we  think, 
feel  and  act;  the  nerves  of  the  eye  take  cognizance  of  external  objects, 
and  convey  their  impressions  to  the  brain;  the  auditory  nerve  distin- 
guishes sounds;  the  olfactory  nerve  identifies  and  separates  the  different 
odors  brought  into  contact  with  it,  and  the  sentient  nerves  of  the  skin 
are  fully  impressed  with  the  touch  of  external  objects,  carry  the  impres- 
sion of  their  character  and  size  to  the  brain,  and  the  motor  nerves  carry 
the  commands  of  the  will  to  the  muscular  system,  that  the  behests  of  the 
mind  may  be  obeyed  and  carried  out ;  the  heart  receives  the  impure  blood 
from  all  parts  of  the  body,  and  sends  it  to  the  limgs  to  be  purified,  then 
receives  it  back  again  and  forces  it  with  enormous  power  even  unto  the 
most  remote  and  minute  part  of  the  system;  the  arteries  and  veins  are 


4:2  THE   HUMAN    BODT. 

made  for  the  express  purpose  of  conveying  the  "pabnlnm  of  life"  from  the 
heart,  and  to  carry  the  vitiated  and  poisonous  fluid  to  the  heart ;  the  lungs 
throw  off  the  carbonic  acid  in  the  venous  blood  and  replace  it  by  oxygen; 
the  stomach,  by  and  with  the  aid  of  the  salivary,  biliary,  pancreatic  and 
intestinal  juices,  digests  the  food  and  transforms  it  into  blood;  the  kid- 
neys are  designed  as  filters,  to  aid  in  the  purification  of  the  blood;  thus 
we  observe  that  the  various  tissues  and  organs  of  the  body  have  each  their 
own  especial  use  in  the  human  economy,  and  their  exact  and  definite  func- 
tion to  perform ;  and  as  a  result  of  the  sum  total  of  the  proper  required 
performance  of  all  these  different  functions,  we  have  not  only  harmony 
and  health,  but  happiness  of  mind,  soul  and  body  as  well. 

MUSCLES  OF  THE  TRUNK  OF  THE  HUMAN  BODY, 

Muscular  Arrangement  and  Blood  Supply — In  this  exquisite  and  mag- 
nificent colored  engraving  we  have  a  grand  view  of  the  wonderful  ar- 
rangement of  the  muscles  of  the  trunk  of  the  human  body,  together  with 
the  muscular  arrangement  of  the  arms  and  likewise  their  blood  supply. 
The  tr^mk  of  the  body  is  divided  into  two  compartments- — the  thorax 
and  abdomen. 

The  Thorax. — The  thorax  derives  its  name  from  the  Greek  word 
thoreo,  and  signifies  "I  leap,"  because  the  heart  leaps  in  it.  It  is  covered 
on  the  front  part  by  large  muscles ;  the  pectoralis  major,  or  large  muscle 
of  the  breast,  is  observed  on  the  left  side  of  the  chest,  whilst  on  the  right 
it  is  removed  and  exposes  the  pectoralis  minor,  or  small  muscle  of  the 
breast.  The  dove-tailed  muscle  observed  on  each  side  is  the  serratus 
magnus,  and  is  employed  in  expanding  and  contracting  the  chest  in  the 
act  of  breathing.  The  muscles  of  the  chest  walls,  in  a  deep  inspiration, 
exert  a  force  equal  to  lifting  a  weight  of  750  pounds. 

Walls  of  the  Abdomen. — The  muscular  walls  of  the  abdomen  are 
nicely  arranged  and  beautifully  adapted  to  the  functions  they  perform. 
On  tlie  left  side  we  see  the  large  oblique  muscle,  so  named  because  of  the 
direction  its  fibres  run,  and  on  the  right  side  we  oljseiwe  the  rectus  muscle, 
the  transverse  muscle  and  internal  oblique  muscle,  all  of  which  are  strong, 
broad  muscles,  whilst  the  manner  in  which  they  are  so  scientifically  ar- 
ranged gives  additional  strength  to  the  abdominal  walls,  without  deterior- 
ating from  its  great  mobility,  and  at  the  same  time  avoiding  all  pressure 
of  the  organs  contained  within  this  large  cavity.  Tliero  are  ninety-one 
muscles  on  each  side  of  the  trunk,  or  one  hundred  and  eighty-two  in  aU, 
ninety  of  which  are  pairs,  and  two  are  single. 


BONES   OF   THE   TEONK   AND   ABMS.  iS 

Muscles  of  the  Shoulder. — The  largo  triangular  muscle  of  the  shoulder 
— ^the  deltoid — is  one  of  great  strength,  as  in  fact  are  all  the  muscles  of 
the  arm.  If  you  gi'asp  the  arm  tightly  just  above  the  elbow-joint,  and 
then  bend  the  fore-arm,  you  will  feel  the  bicejDS  muscle  of  the  arm  become 
firm,  hard  and  prominent;  now  straighten  it  again  and  it  becomes  re- 
laxed, whilst  the  muscles  on  the  back  of  the  arm  beeojue  hard  and  prom- 
inent. The  muscles  of  the  fore-arm  are  the  flexors  and  pronators;  that 
is,  they  flex  the  arm  and  turn  the  palm  downward.  In  each  upper 
extremity  or  arm  there  are  fifty-three  muscles,  and  we  observe  here  the 
nicest  and  most  economical  method  of  packing  away  the  muscles  that 
could  be  improvised,  securing  strength,  giving  elegance  to  its  form  and 
Bhaj^e  and  facilitating  its  mobility. 

Blood  Supply  of  Arm — On  the  right  arm  we  obtain  a  glimpse  of  the 
blood  supply  of  the  arm;  we  sec  the  brachial  artery  giving  off  numerous 
branches,  and  observe  the  radial  and  ulnar  arteries  doing  the  same  thing; 
thus  securing  ample  nourishment  to  preserve  the  health,  strength  and 
beauty  of  the  arm. 

BONES  OF  THE  TKUNK  AND  ABMS. 

Different  Forms  of  Bones — On  turning  over  this  flap  we  are  brought 
face  to  face  with  a  grim  looking  but  useful  object — the  frame  work  of 
the  trunk  and  arms.  The  skeleton  is  of  a  ghastly  appearance  and  em- 
blematic of  death;  its  unsightly  look  sends  a  thrill  of  horror  through 
us,  and  we  instinctively  recoil  from  it.  Yet  it  subserves  a  useful  purpose 
in  the  human  body,  and  the  ugly  looking  bones,  when  carefully  examined, 
abound  in  nice  contrivances  and  ingenious  workmanship;  whilst  each 
individual  Iwne  is  designed  for  the  esj^ecial  duty  it  has  to  perform.  Hence 
the  bones  differ  in  form;  some  are  long,  as  in  the  arms  and  legs;  some 
are  short  and  thick,  giving  strength  and  compactness,  as  in  the  lumbar 
portion  of  the  spine ;  some  are  flat,  for  covering  a  cavity,  as  the  skull  and 
pelvis,  and  others  used  for  a  special  purpose  are  irregular,  as  in  the  hands 
and  feet. 

Combined  Lightness  and  Strength.— But  notwithstanding  this  diver- 
sity in  form,  the  general  plan  constantly  kept  in  view  by  the  Divine 
Architect  has  been  the  central  idea  of  combining  lightness  with  the  great- 
est possible  degree  of  strength.  The  bones  of  the  arms  and  legs  are  round, 
or  triangular,  and  hollow,  thus  giving  with  the  same  weight  a  greater 
degree  of  strength  than  if  solid,  besides  affording  a  larger  surface  for  the 
attachment  of  muscles. 


44  THE    310MAN    BODY. 

Composition  of  the  Chest — The  chest  is  composed  of  bones,  cartilages 
and  ligaments.  Its  natural  form  is  that  of  a  cone  diminishing  upward; 
and  it  affords  lodgment  for  the  heart,  lungs  and  large  blood-vessels.  Its 
walls  are  formed  posteriorly  by  the  seven  dorsal  bones  of  the  spinal  col- 
umn, and  the  ribs  as  far  as  the  angle,  the  sides  by  the  body  of  the 
ribs,  and  front  by  the  ribs,  the  costal  cartilages  and  the  breast  bone. 

The  E.ibs — The  ribs  are  twenty-four  in  number,  arranged  in  pairs, 
twelve  on  each  side  of  the  chest.  At  the  back  they  are  fastened  to  the 
spine,  and  in  front  the  seven  upper  pairs  are  tied  by  cartilages  to  the 
breast  bone,  three  are  fastened  to  each  other  and  the  cartilage  above,  and 
two,  the  floating  ribs,  are  loose.  The  long,  slender  ribs  give  lightness ; 
their  arched  form  confers  strength,  and  the  cartilages  impart  elasticity ; 
thus  the  three  most  essential  pre-requisites  of  the  chest  for  the  protection 
of  the  delicate  organs  contained  within  this  cavity  are  secured,  whilst  the 
freest  motion  in  respiration  is  ensured. 

The  Pelvis — The  pelvis  is  an  irregular-shaped  basin,  formed  by  the 
hip  bones  and  the  pubic  bones  in  front.  In  the  npper  and  back  part  is 
the  foot  of  the  spinal  coliimn,  consisting  of  a  wedge-shaped  bone  called 
the  sacrum.  It  is  observed  firmly  planted  between  the  wide  spreading 
hip  bones  of  the  ]ielvis,  like  the  keystone  of  an  ai-ch,  and  gives  a  strong 
support  to  the  bunion  above. 

The  Spinal  Column — The  spinal  column,  the  lumbar  portion  of  which 
is  here  seen,  consists  of  twenty-four  bones,  between  which  are  placed 
pads  of  cartilage.  Such  is  the  elasticity  of  these  cushions  of  cartilage, 
that,  though  they  become  condensed  through  the  day,  making  us  shorter 
in  the  evening  than  in  the  morning,  they  resume  their  normal  thickness 
wliile  we  are  lying  in  bed  at  night.  The  perfection  in  the  architecture 
of  the  spine  surpasses  belief;  its  various  uses  seem  a  bundle  of  contra- 
dictions. 

Bones  of  the  Spinal  Column — Tlie  twenty-four  bones  of  which  it  coti- 
sists  are  so  stiffly  locked  together  as  to  form  a  chain  that  will  bear  and 
support  the  heaviest  of  burdens,  yet  so  flexible  that  it  will  bend  like  India 
rubber;  within  this  wondroiis  column  hides  a  delicate  nerve  that  would 
thrill  at  the  gentlest  touch,  yet  so  securely  does  it  rest  in  its  bony  couch 
that  it  feels  not  the  slightest  jar  or  shock;  and  resting  upon  this  remark- 
able pillar  of  bones  is  borne  the  brain,  without  a  tremor  or  a  fear  of 
danger ;  to  it  are  foimd  clinging  the  vital  organs  of  the  chest  and  abdomen, 
secure  in  the  protection  it  affords. 

The  Shoulder  Joint. — Tlie  shoulder  joint,  formed  as  it  is  by  the 
ehoulder-blade  (scapula),  collar  bone  (clavicle),  and  the  arm  bone,  is  most 


THE    LtTNOs;    TlIElK    MtClIANISM    AND    WONbEKS.  45 

beautifully  designed  and  executed.  It  comprises  a  shallow  ball  and  socket- 
joint,  thus  affording  the  freest  rotary  movements.  The  shallowness  of  the 
socket,  however,  accounts  for  the  frequent  dislocations  of  this  joint;  but 
that  is  compensated  for  by  the  easy,  graceful  carriage  and  swing  of  the 
arm,  which  a  deeper  socket  would  not  permit. 

The  Collar  Bone — The  collar  bone  is  fastened  at  one  end  to  the  breast 
bone  and  first  rib,  and  at  the  other  end  to  the  shoulder  blade.  It  thus 
holds  the  shoulder-joint  out  from  the  chest,  aids  in  protecting  the  import- 
ant vessels  of  the  axilla,  and  gives  the  arm  a  greater  range  of  freedom, 
mobility  and  play. 

THE  LUNGS;  THEIR  MECHANISM  AND  WONDERS. 

What  the  Lungs  Are. — The  lungs !  Dense  looking  objects,  and  yet 
how  light  and  buoyant !  This  beautiful  anatomical  chart  shows  us  a  front 
view  of  the  chest  and  lungs,  with  the  lungs  enclosed  within  the  bony 
basket-work  of  the  chest.  The  lungs  are  two  large,  conical  bodies,  placed 
one  on  each  side  of  the  chest,  and  occupy  the  greater  part  of  its  cavity. 
•  During  life  they  accurately  adapt  tliemselves  to  the  varying  dimensions 
of  the  chest ;  for,  imhappily,  the  foibles  of  fashion  very  frequently  cause 
restriction  of  the  lungs,  by  interfering  with  the  resistance  and  freedom 
of  movement  of  the  ribs,  so  essential  to  health,  by  tight  lacing  and  the 
barbarous  usage  of  corsets. 

Pleura  of  the  Lungs — In  this  chart  we  see  also  the  pleura  or  the  in- 
vesting membrane  of  the  lungs,  and  right  below  it  the  diaphragm  or 
midriff. 

Two  Distinct  Lungs — ^Although  the  lungs  are  two  in  number,  as  far 
as  their  structure  is  concerned,  and  are  perfectly  distinct  from  each  other, 
having,  as  we  obsei"ve  in  the  chart  underneath  this  one,  the  heart  and 
blood-vessels  between  them,  yet  as  regards  their  functions  they  may  be 
considered  the  same,  since  they  receive  their  blood  from  a  single  vessel, 
the  pulmonary  artery,  and  the  air  by  one  canal,  the  trachea  or  wind-pipe, 
and  act  in  common  with  each  other. 

Size  and  Shape  of  Lungs. — As  will  be  observed,  the  lungs  are  not 
quite  the  same  size  or  shape;  the  right  lung,  although  somewhat  shorter 
and  thicker  than  the  left,  is  the  larger  and  stronger,  being  divided  into 
three  lobes;  whilst  the  left  is  the  smaller  and  weaker,  divided  into  two 
lobes  only,  and  hence  more  frequently  subject  to  disease. 

Weight  and  Shape  of  Lungs. — The  weight  of  the  lungs  varies  very 
much;  but  in  general  they  average  about  forty-two  ounces  in  the  malej 


46  Tiri!    HUMAN    BODY. 

thirty-six  in  the  female;  the  right  hmg  being  about  two  oimces  heavier 
than  the  left.  Each  lung  is  conical  in  shape,  with  a  broad  concave  baae 
resting  on  the  convex  surface  of  the  midriff,  the  apex  directed  upward  and 
extending  into  the  root  of  the  neck  about  one  inch  above  the  level  of 
the  first  rib. 

Interior  Arrangement  of  Lungs. — On  turning  this  flap  over  wo  find  a 
vertical  section  of  the  lungs,  showing  their  interior  arrangements.  The 
lower  end  of  the  trachea  divides,  one  portion  going  to  each  lung.  These 
again  subdivide  and  continue  to  subdivide  in  geometrical  order,  growing 
smaller  and  smaller  with  each  division,  and  extending  to  every  part  of 
the  lungs,  finally  terminating  in  a  cluster  of  air  cells,  bound  together  by 
cellular  tissue  and  forming  a  lohide.  These  lobules  vary  in  size  ac- 
cordingly as  they  ai"e  located  on  the  siirface  of  the  lung  or  deeper  in  its 
tissues.  Each  lobule  is  separate  and  distinct  from  the  other,  and  forms 
in  itself  a  ]>erfect  and  independent  lung  in  miniature. 

Function  of  the  lobules — In  this  arrangement  we  see  the  boundless 
■wisdom  of  the  Creator  displayed,  for  were  it  not  for  this  wise  and  perfect 
provision — one  of  the  very  greatest  importance  in  the  process  of  respira- 
tion, since  it  enables  each  individual  lobule  to  perform  its  functions  inde- 
pendently of  the  rest — tubercular  disease,  bronchitis  and  inflaiumation 
of  the  lungs  would  not  only  be  incurable,  but  would  prove  to  be  very 
rapidly  fatal. 

Lung  Air  Cells — Each  air  cell  varies  in  size  from  the  seventieth  to 
the  one  two-hundredth  part  of  an  inch  in  diameter.  The  number  of  air 
cells  in  the  two  lungs  is  truly  surprising,  there  being  certainlj'  not  less 
than  600,000,000,  though  according  to  Dr.  Addison's  computation  there 
are  1,700,000,000,  equivalent  to  1,500  square  feet  of  surface  on  which 
the  process  of  purifying  the  blood  is  constantly  and  continuously  going 
on  in  a  healthy  lung. 

Blood-vessels. — On  the  next  flap  we  have  a  graphic  illustration  of  the 
internal  arrangements  of  the  blood-vessels  of  the  lungs  and  bronchial 
tubes.  The  pulmonary  artery,  arising  from  the  right  ventricle  of  the 
heart,  conveys  the  venous  blood  to  the  lungs.  It  penetrates  the  lungs  and 
divides  and  subdivides  into  branches,  which  accompany  the  bronchial 
tubes  and  terminate  in  a  dense  capillai-y  net-work  upon  the  walls  of  the 
air  cells,  where  the  blood  undergoes  that  magical  change,  giving  ujj  its 
poisonous  qualities  and  becoming  revivified  and  healthful. 

Pulmonary  Veins. — Erom  this  net-work  of  arteries  and  air  colls  the 
radicles  of  the  pulmonary  veins  arise,  and,  coalescing  into  larger  and 
larger  branches,  at  length  accompany  the  arteries  and  returq  the  blood  to 


THE  LUNGS  ;  THEIR  MECHANISM  AND  WONDERS.  .  '^1 

the  left  anriclc  of  the  heart  in  a  purified  condition.  The  pulmonary  ar- 
teries and  veins  differ  from  the  same  vessels  in  other  parts  of  the  body, 
since  the  former  conveys  venous  blood,  and  the  latter  arterial  blood. 

Breathing — Kespiration,  or  the  act  of  breathing,  consists  of  the  alter- 
nate inspiration  and  expiration  of  air  to  and  from  the  lungs ;  in  the  pro- 
cess of  which  the  lungs  themselves  are  almost  passive  instruments,  since 
their  contraction  and  expansion  takes  place  by  means  of  the  muscles  which 
surround  the  chest.  The  diaphragm  or  midriff,  which,  when  at  rest  and 
the  lungs  empty,  forms  a  beautiful  dome  to  the  abdominal  cavity,  becomes 
depressed  during  the  inspiratory  process,  and  presses  the  walls  of  the 
abdomen  outward.  At  the  same  time  the  ribs  become  elevated,  thus  in- 
creasing the  size  of  the  client.  Thereupon  the  elastic  lungs  expand  to 
occupy  the  entire  space,  whilst  the  current  of  air,  in  obedience  to  a  well- 
known  physical  law,  rushes  dovra  the  wind-pipe  and  enters,  the  numerous 
air-cells,  the  result  of  which  is  inspiration.  In  exjiiration  the  reverse  of 
this  takes  place.  "We  bend  forward,  draw  the  abdominal  walls  inward, 
press  the  diaphragm  upward,  whilst  the  ribs  are  pulled  downward.  All 
these  acts  simultaneously  performed  decrease  the  size  of  the  chest,  and 
force  or  exjicl  the  air  from  the  lungs. 

Breathing  Capacity  of  Lungs — The  breathing  capacity  of  the  lungs 
bears  a  close  correspondence  to  the  stature  of  man.  For  an  ordinary- 
sized  man  of  about  five  feet  eight  inches  in  height,  it  will  be  230  cubic 
inches,  or  about  one  gallon  of  air,  and  for  each  additional  inch  in  stature 
up  to  six  feet,  there  will  be  an  increase  of  eight  cubic  inches.  In  a  forcible 
expiration  all  the  air  in  the  lungs  is  not  expelled ;  there  still  remains  be- 
hind 100  cubic  inches.  Thus,  with  this  unexpclled  air,  the  breathing 
capacity  of  an  ordinary-sized  man  is  about  330  cubic  inches,  or  equivalent 
to  11  pints  of  air.  Of  the  230  cubic  inches,  100  can  only  be  forced  into 
the  lungs  by  the  exercise  of  great  effort,  and  Is  available  for  emergencies, 
as  striking  a  heavy  blow,  or  for  the  purpose  of  training,  as  in  singing, 
rowing,  running,  climbing,  etc. ;  but  tlio  extra  amount  of  air  always  on 
hand  in  the  hmgs  is  of  great  value,  since  it  enables  the  lungs  to  perform 
their  functions  continuously,  even  under  severe  and  violent  exertions. 

Giving  Up  of  Oxygen. — The  atmosplieric  air  laden  with  its  life-sus- 
taining property,  oxygen,  having  passed  into  the  lungs,  gives  up  that 
vital  element  and  receives  In  Its  place  the  carbonic  acid  gas,  water,  and 
other  refuse  materials  which  the  blood  has  picked  up  in  its  journey 
through  the  body,  and  which  are  no  longer  fitted  to  circidate  In  the  blood 
and  preserve  the  vitality  of  the  body.  ]^o  tonic  invigorates  so  well  as  a 
few,  deep,  full  inspirations  of  pure,  cold  air. 


48  THE    HUMAN    BODY. 

Circuit  of  the  Blood. — The  bluoJ  thus  purified  passes  back  to  the 
heart  to  go  on  its  circuit  through  the  body,  every  organ  of  which  renews 
its  energy  and  vigor  from  the  magician's  fiery  wand,  pure,  healthy  blood ; 
while  the  air  exhaled  carries  off  the  impurities. 

Change  in  Color  of  the  Blood — During  this  process  the  blood  changes 
from  a  dark  purple  to  a  bright  red.  Pure  air  is  the  cheapest  necessity 
and  the  gi-eatest  luxury  of  life.  Let  it  not  be  the  rarest.  The  relative  pro- 
portion of  the  respirations  to  the  pulsations  of  the  heart  is  about  1  to  4|- 
or  5 ;  and  the  quantity  of  air  required  to  keep  the  blood  pure  is  very  great. 
Indeed,  respiration  is  the  falling  weight,  the  bent  spring,  which  keeps 
the  clock  of  life  in  motion ;  the  inspirations  and  expirations  are  the  strokes 
of  the  pendulum  which  regulate  it. 

Delicacy  of  the  Organs — The  perfection  of  the  organs  which  carry 
on  this  stupendous  office  challenges  our  warmest  admiration.  So  delicately 
are  they  arranged  that  the  slightest  pressure  will  cause  intense  pain,  yet 
tons  of  air  surge  to  and  fro  through  their  intricate  passages,  and  bathe 
their  innumerable  cells  without  our  knowledge,  so  to  speak,  of  its  coming 
and  going.  We  annually  perform  over  8,400,000  acts  of  breathing,  in- 
hale over  150,000  feet  of  air,  and  purify  nearly  4,000  tons  of  blood ! 
This  gigantic  and  unbiirdensome  process  goes  on  constantly,  never  weary- 
ing or  worrying  us  when  in  robust  health,  and  we  are  struck  dumfounded 
with  amazement  when  the  cold  calculations  of  science  reveal  to  us  its 
magnitude  and  marvelousness. 

Second  Use  of  Breathing. — l^Tor  is  this  stupendousness  all.  Nature 
dislikes  a  waste  of  energy.  In  addition  to  and  by  a  wise  adaptation  and 
economy,  the  process  of  respiration  is  made  to  subserve  a  second  use  no 
less  important  than  that  of  purifying  the  blood — the  power  of  speech. 
The  exhaled  air,  laden  though  it  may  be  with  the  human  detritus  and 
off-scourings  of  the  body,  in  passing  through  the  vocal  organs  can  be  trans- 
formed into  prayers  of  faith,  songs  of  hope  and  words  of  good  cheer, 
kindly  encouragement  and  expressions  of  love! 

THE  HEART  AND  ITS  WONDERS. 

What  the  Blood  Is. — The  blood — ^the  pabulum  of  life — has  not  in- 
aptly been  termed  "Liquid  Flesh."  But  it  is  more  than  that,  since  it  con- 
tains the  materials  so  essential  and  so  requisite  for  the  building  up  and 
repair  of  every  organ  and  tissue  of  which  the  body  is  composed.  The 
blood  is  the  liquid  by  means  of  which  the  circulation  in  the  body  is  car- 
ried on;  it  permeates  every  nook  and  comer  of  the  system,  and  is  com- 


THE   HEART   AMD   ITS    WONDERS.  49 

posed  of  a  thin,  colorless  fluid,  the  i^lasnva,  filled  with  red  disks,  so  small, 
flat  and  thin  that  it  requires  3,500,  placed  side  by  side,  to  measure  one 
inch,  and  no  less  than  18,000,  placed  one  upon  the  other,  to  make  a  col- 
umn one  inch  in  height.  These  disks  are  continually  forming  and  as  con- 
stantly dying. 

Coagulation  of  the  Blood. — According  to  Dr.  Draper,  of  ISTew  York, 
20,000,000  die  at  a  single  breath !  Blood  when  exposed  to  the  air  coagu- 
lates, and  the  value  of  this  peculiar  yet  intrinsic  property  cannot  be  over- 
estimated. When  an  artery  is  ruptured  bleeding  takes  place,  the  blood 
coagulates  and  forms  a  plug,  thus  preventing  further  hemorrhage.  Thus 
we  observe  with  what  Divine  foresight  and  wisdom,  not  only  the  wants 
of  the  body  are  provided  for,  but  also  the  accidents  to  which  it  is  liable. 

Size,  Shape  and  Location  of  the  Heart — ^In  this  beautiful  anatomical 
chart  we  obtain  an  accurate  idea  of  the  relative  size,  shape  and  position  of 
that  wonderful  engine,  the  heart,  whose  tireless  efforts  to  keep  the  wheels 
of  life  in  motion  are  truly  surprising,  and  fill  us  with  amazement  at  the 
prodigious  work  it  daily  performs.  The  heart  is  an  irregular,  pear-shaped, 
hollow,  muscular  organ,  placed  obliquely  in  the  lower  and  front  part  of 
•the  chest,  between  the  two  lungs  and  inclining  to  the  left  of  the  centre. 
The  base  is  directed  toward  the  spine  and  corresponds  with  the  fourth  and 
fifth  dorsal  spinal  bone,  while  the  apex  points  between  the  cartilages  of 
the  fifth  and  sixth  ribs  on  the  left  side.  In  this  illustration  the  peri- 
cardium, or  loose  sac  in  which  the  heart  is  enclosed,  is  removed,  and  we 
see  the  coronary  artery  with  its  branches  distributed  over  the  outer  sur- 
face of  the  complex  and  restless  organ. 

Heart  a  Double  Organ. — On  looking  at  the  heart  one  would  think 
it  was  a  single,  solid  organ.  It  is  not,  however,  but  a  double  organ,  divided 
into  four  compartments ;  the  two  upper  ones,  from  their  supposed  resem- 
blance to  a  dog's  ear,  are  called  auricles,  and  the  lower  ones,  from  resem- 
bling a  little  stomach,  are  called  ventricles.  The  auricle  and  ventricle  on 
each  side  communicate  with  one  another,  but  the  right  and  left  halves 
of  the  heart  are  each  separate  and  distinct  organs,  and  perform  different 
functions — the  right  side  propels  the  dark,  vitiated  and  impure  blood, 
whilst  the  left  deals  with  the  bright  crimson,  life-giving  and  life-sus- 
taining blood. 

Use  of  the  Auricles. — The  auricles  serve  as  reservoirs  to  receive  the 
blood — the  right,  as  it  comes  dark  and  foul  from  its  tour  of  the  body, 
the  left,  as  it  filters  bright  and  pure  from  the  oxygenated  forest  of  the 
lungs — and  to  furnish  it  to  the  veutriclps  as  they  need  it.  This  is  graphic- 
ally shown,  on  the  chart,  the  large  blue  vein,  formed  by  the  jugular  and 


50  THE  HUMAN  BODY. 

subcliiviaii  veins,  is  seen  descending  downward  and  emptying  into  the 
right  anricle;  the  red  piilnionarj  vein,  fornied  by  the  coalescing  of  its 
numerous  branches,  conveying  rich,  pure  blood  from  the  lungs  and  de- 
positing it  in  the  left  aiu-icle.  Oorrespouding  to  the  lightness  of  the  work 
they  perform,  tlie  walls  of  the  auricles  are  comparatively  thin  and  weak. 

Ventricles  of  the  Heart. — The  walls  of  the  left  ventricle,  which  pro- 
pels the  blood  to  the  remotest  comers  of  the  human  frame,  are  corre- 
spondingly thicker  and  stronger  than  those  of  the  right,  which  forces  the 
blood  to  the  limgs  only.  Arising  from  the  right  ventricle  is  seen  the 
blue  pulmonary  artery,  conveying  its  foul,  poisonous,  vitiated  and  venous 
stream  to  the  lungs,  while  from  the  left  ventricle  is  observed  the  large 
mnin  artery  of  the  circulatory  system — tbe  aorta — from  the  arch  of  which 
arise  the  right  and  loft  carotid  arteries. 

Changes  in  the  Human  Body — The  huimm  body  is  in  a  constant  state 
of  change.  In  the  midst  of  life  there  is  death.  The  blood  disks  die  and 
new  ones  are  bom  into  life.  Every  act  of  life  is  destructive  as  well  as 
constructive.  Kot  a  thought  can  be  evolved  but  numerous  brain  cells  die ; 
not  a  wink  of  the  eye,  a  smell  of  a  lovely  rose,  nor  a  muscular  movement, 
but  results  in  the  death  of  some  part  of  the  machinery  involved.  Every 
l^nx-ess  of  life  is  a  process  of  death.  The  scales  of  the  epidermis  are  con- 
stantly' falling  off  and  being  replaced  by  fresh  cells  from  beneath,  and  it 
is  on  the  continuance  of  this  interchange  that  our  life,  health  and  vigor 
depends.  The  more  rapidly  this  change  goes  on,  and  fresh,  vigorous, 
liealthy  tissues  take  the  place  of  the  old  lifeless  ones,  the  more  elasticity, 
buoyancy  and  strength  we  possess — the  more  healthy  and  robust  we 
become. 

Work  of  the  Heart — 'No  slave  ever  performed  his  work  more  patient- 
ly than  the  heart.  Its  quivering  task  is  essential  to  life  and  health.  It  is 
the  fountain  from  whence  tlie  spirit  flows,  and  on  the  faithful  perform- 
ance of  its  fimctions  every  part  of  the  lx)dy  depends  for  the  warm  stream 
of  life,  motion  and  vigor  which  it  unstintingly  fixmishes.  The  ancients 
believed  the  heart  to  be  the  seat  of  love.  Within  its  walls  were  located 
all  that  was  pure,  tme,  good  and  noble,  as  well  as  the  evil  passions  of  the 
soul.  i\jid  although  modem  science  has  foimd  the  seat  of  mind,  reason, 
consciousness  and  the  mental  powers  to  be  located  in  the  brain,  and  thus 
robbed  the  heart  of  its  romance,  yet  it  has  revealed  wonders  comiected 
with  this  small  organ,  that  certainly  eclipse  the  mysteries  associated  ^^^th 
it  in  the  past.  Pit-a-pat !  pit-a-pat !  throbs  this  marvelous  engine,  and  in 
response  to  its  constant  tlirolibing  the  blood  bounds  along  the  myi-iad  of 
tubes,  conveying  messages  of  life  and  health. 


THE    DIGESTIVE    APPABATTTS    AND    ITS    WONDEES.  51 

Constancy  of  Heart  Work — Our  mind  cannot  stop  its  beatings ;  it  can- 
not stop  itself;  sleep  does  not  interfere  with  its  workings,  and  our  daily 
labor  only  strengthens  its  force  and  regularity.  This  wonderful  organ 
throbs  on  night  and  day,  week  in  and  week  out,  the  year  round,  with 
ceaseless,  tireless  energy.  It  beats  at  the  rate  of  100,000  strokes  per 
day,  40,000,000  per  year,  and  not  unfrequently,  2,800,000,000  without 
a  single  stoppage.  It  is  the  most  powerful  engine  known  to  science.  Its 
daily  work  is  equal  to  one-third  of  that  of  all  the  muscles  of  the  body.  If 
it  should  expend  its  entire  force  in  lifting  its  own  weight  vertically,  it 
would  rise  20,000  feet  in  an  hour.  The  greatest  exploit  ever  accomplished 
by  a  locomotive  was  to  lift  itself  through  less  than  one-eighth  of  that 
distance.  Vast  and  constant  as  is  this  perpetual  throbbing,  so  perfect  is 
the  machinery  with  which  it  is  carried  on,  that  there  are  those  who  do 
not  even  know  where  the  heart  lies  until  disease  or  accident  reveal  its 
location. 

Vitality  of  the  Heart — Its  vitality  is  as  amazing  as  its  strength. 
While  life  exists  this  tireless  organ  never  stops.  In  disease,  as  long  as 
a  flutter  of  this  wondrous  organ  exists,  wo  know  the  spark  of  life  has  not 
altogether  vanished,  and  now  hope  is  begotten  that  health  may  be  restored. 
During  such  long  lives  as  wo  sometimes  see,  the  heart  has  propelled  no 
less  than  500,000  tons  of  blood;  and  yet,  during  all  this  patient,  unfalter- 
ing and  unflinching  labor,  it  has  repaired  itself  as  the  waste  has  occurred. 

Heart  Rhythms — The  rhythm  of  its  beats  never  fails  until  death 
breaks  into  the  casket  and  seizes  the  ever  throbbing  pendulum  at  the 
command  of  the  great  Master  Workman,  silencing  the  quivering  muscles 
of  the  heart  and  compelling  the  wheels  of  life  to  stand  still. 

THE  DIGESTIVE  APPARATUS  AND  ITS  WONDERS. 

Value  of  the  Plates. — Seeing  is  believing;  nay,  it  is  more,  it  is  know- 
ing and  remembering.  The  mere  reading  of  a  statement  on  any  particular 
subject  docs  not  always  advance  our  knowledge  of  the  matter  in  question. 
The  observation  of  a  fact,  or  its  proper  illustration  by  appi'opriatc  dia- 
grams, such  as  we  observe  these  anatomical  charts  to  be,  not  only  em- 
phasizes the  point  considered,  but  aids  us  in  remembering  the  principal 
features  connected  with  tlie  functions  perfonned,  thus  advancing  our 
knowledge  of  the  subject  discussed,  and  educational  progress  is  made. 

Quantity  and  Variety  of  Foods. — As  we  have  already  seen,  the  human 
body  consists  of  numerous  mechanics  or  artisans,  who  are  constantly  at 
work  repairing  and  upbuilding  the  miceasing  destruction  that  is  cohtin- 


62  THE   HUMAN    BODY. 

ually  going  on.  If  fresh  food  be  not  daily  supplied,  this  work  would  soon 
cease,  and  the  lamp  of  life  flicker  out.  To  replace  this  constant  waste  we 
require  nearly  three  pounds  of  solid  food,  and  fully  three  pounds  of  liquid 
food  for  our  daily  allowance.  But  to  convert  the  pent-up  energies  of 
bread,  meat  and  vegetables  into  the  tissues  of  our  own  mechanism  re- 
quires a  number  of  differently  constructed  organs,  and  these  we  now 
desire  to  draw  your  attention  to  in  this  beautiful  chart.  The  organs  con- 
sist of  the  stomach,  liver,  pancreas  and  intestines,  which  comprise  the 
principal  organs  concerned  in  the  process  of  digestion. 

The  Stomach. — The  stomach  is  an  irregular  expansion  of  the  gullet 
or  cesophagTis,  and  is  the  receptacle  which  receives  the  food  when  swal- 
lowed. Its  shape  has  been,  not  inaptly,  likened  to  the  Scotch  bagpipe. 
It  will  hold  about  three  pints,  though  it  is  capable  of  considerable  dis- 
tension. When  moderately  filled  with  food  it  measures  about  twelve 
inches  in  length  by  four  inches  in  diameter  at  its  widest  end.  The  walls 
of  the  stomach  consist  of  four  distinct  coats,  held  together  by  fine  areolar 
tissue,  and  are  arranged  in  the  following  order,  from  within  outward: 
the  mucous,  the  areolar,  the  muscular  and  the  serous.  The  inner  mucous 
coat  is  a  smooth,  soft,  rather  thick,  pulpy  membrane,  loosely  connected 
with  the  muscular  coat,  and  secretes  the  gastric  digestive  fluid  of  the 
stomach. 

Fine  View  of  Stomach  Coatings. — On  turning  over  the  flap  we  obtain 
a  very  fine  view  of  this  remarkable  membrane.  The  areolar  coat  is  placed 
between  the  muscular  and  mucous  coats,  and  connects  with  both.  The 
muscular  coat  is  very  thick  and  stout,  and  composed  of  three  sets  of  fibres, 
the  longitudinal,  circular  and  oblique,  which  form  three  distinct  layers. 
The  outer  coat  is  a  thin,  smooth,  transparent  and  elastic  membrane,  de- 
rived from  the  peritoneum,  and  well  lubricated  to  prevent  friction. 
When  the  fibres  of  the  muscular  wall  contract,  a  peculiar  churning  move- 
ment of  the  stomach  is  produced,  thus  securing  the  thorough  mixing  of  its 
contents,  that  every  particle  may  come  into  contact  with  the  solvent  prop- 
erties of  the  gastric  juice. 

The  Pyloric  Gate. — At  the  smaller  end  the  muscular  fibres  contract 
and  form  a  gateway — the  pylorus,  as  it  is  called — which  carefully  guards 
the  exit  from  the  stomach,  and  allows  no  food  to  escape  until  properly 
prepared.  The  gastric  blood-vessels  are  seen  distributing  themselves  over 
the  outer  surface  of  the  organ,  thus  ensuring  its  nutrition  and  repair. 

.  The  liver The  liver  is  the  secreting  organ  by  which  the  bile  is 

formed.  It  is  situated  on  the  right  side  below  the  diaphragm,  and  is  of 
a  reddish-brown  color.    It  is  irregular  in  form,  being  convex  on  the  upper 


irHE  DIGESTIVE  APPARATUS  AND  ITS   "WONDEEg.  53 

surface,  irregularly  concave  behind,  very  thin  in  front,  and  weighs  aboiit 
four  pounds.  It  is,  therefore,  seen  to  be  the  largest  organ  or  gland  in 
the  body.  It  is  divided  into  two  lobes,  the  right  and  the  left,  the  former 
being  by  far  the  larger.  On  turning  the  flap  over,  we  see  how  intricately 
it  is  arranged  internally. 

Blood-vessels  of  the  Liver. — The  blood-vessels  of  the  liver  are  the 
hepatic  artery  and  veins,  and  the  portal  vein;  the  lymphatic  vessels  are 
numerous,  and  the  nerves  are  supplied  from  the  pneumogastric,  the 
phrenic  and  the  hepatic  plexus.  The  liver,  therefore,  receives  two  kinds 
of  blood:  the  arterial,  by  means  of  the  hepatic  artery,  and  the  venous, 
from  the  portal  vein,  from  which  the  bile  is  principally  formed.  The  bile 
is  a  dark,  golden  fluid,  of  extremely  bitter  taste,  of  which  three  pounds 
is  secreted  daily.  When  not  used  in  digestion  it  is  stored  away  in  the 
gall-bladder,  a  fine  view  of  the  location  of  Avhich  we  have  in  this  chart. 
The  action  of  the  bile  on  food,  though  not  fuUy  understood,  is  necessary 
for  perfect  digestion. 

The  Pancreas,  or  "Sweetbread." — The  pancreas,  or  "sweetbread,"  is  a 
single  glandular  organ,  situated  transversely  across  the  upper  and  back 
part  of  the  abdomen,  on  a  level  with  the  last  dorsal  spinal  bone.  It  is 
of  an  irregular,  elongated  form,  from  six  to  eight  inches  in  length,  an 
inch  and  a  half  in  breadth,  and  from  a  half  to  one  inch  in  thickness.  It 
secretes  about  seven  ounces  daily  of  a  slightly  alkaline  fluid  containing 
an  organic  principle — pancreatin,  which  has  the  property  of  changing  the 
starchy  food  into  sugar.  ^Tiilst  it  has  this  power,  yet  its  chief  work  in 
the  digestive  process  seems  to  be  tlie  breaking  up  of  the  fat  globules  into 
myriads  of  minute  particles  which  mix  freely  with  water,  and  thereby 
promote  their  absorption  by  the  lacteals. 

The  Intestines. — The  next  chart  shows  us  the  manner  in  which  the 
intestines  are  arranged  in  the  abdominal  cavity.  The  entire  intestinal 
canal  is  about  thirty  feet  in  length,  and  is  divided  into  two  portions — the 
small  intestines,  and  the  large  intestines;  these  again  are  each  subdivided 
into  three  different  portions.  Of  the  large  intestines,  the  transverse  por- 
tion is  laid  open,  showing  the  internal  arrangements.  A  section  of  the 
bladder  is  seen  on  this  chart. 

Machinery  of  Digestion. — ^From  the  number  and  differently  formed 
structures  which  constitute  the  digestive  organs,  it  will  be  observed  that 
that  function  is  a  very  highly  complex  process.  If  the  food  were  thrown 
directly  into  the  circulating  fluid,  it  could  not  be  used  for  the  purpose  of 
nutrition.  It  requires  for  its  transformation  into  blood,  bone  and  muscle, 
^  series  of  complex,  machinery,  each  part  of  which  is  specially  designed 


Si  [TECB  ■HTJMAir   BODY. 

for  the  particular  part  it  plays  in  tliis  wonderful  and  complicated 
process. 

TJse  of  Mouth  and  Teeth — The  mechanical  part,  which,  although  not 
shown  in  this  chart,  may  be  carefully  studied  in  the  chart  giving  the  dif- 
ferent views  of  the  head,  is  performed  by  the  mouth  and  teeth,  and  the 
pulverized  food  is  subjected  to  the  action  of  the  saliva.  The  lubricated 
morsel  of  food  is  now  gathered  into  a  ball  and  conveyed  to  the  back  of 
the  mouth  by  the  muscles  of  the  cheek  and  tongue.  On  its  arrival  here, 
the  soft  palate  lifts  upward  and  closes  the  posterior  nasal  openings; 
the  epiglottis  shuts  down  over  the  trachea  or  "wind-pipe,  forming  a  bridge 
over  which  the  food  passes,  thus  preventing  it  from  falling  into  the  res- 
piratory track. 

Duty  of  the  Throat — The  muscular  bands  of  the  throat  now  grasp 
it  and  pass  it  do^\Ti  the  gullet  into  the  stomach,  beyond  our  control.  Here 
it  comes  into  contact  with  the  gastric  juice,  undergoes  the  churning  motion 
of  the  stomach,  is  guarded  over  by  the  pylorus,  thoroughly  saturated  and 
mixed  before  entering  into  the  intestinal  track,  where  it  is  subjected  to 
the  action  of  the  bile,  the  pancreatic  juice  and  the  intestinal  fluid,  each 
with  its  special  duty  to  perform. 

Nature's  Treasures  Open  to  Man — All  this  is  a  very  complicated  and 
diversified  process,  the  necessity  for  which  can  only  be  explained  upon 
the  hyiiothesis  that  Xature,  in  her  exhaustlcss  munificence,  has  opened 
her  proud  domains,  and  poured  forth  to  man  the  treasures  of  every  land 
and  every  sea  for  food;  the  cornfields  wave  their  golden,  grain  for  him; 
the  wheat,  rye,  oats,  coria,  maize,  rice,  each  different,  yet  highly  nutri- 
tious and  sufficing;  the  palm,  the  date,  the  banana,  the  fig,  the  pineapple, 
spread  out  a  delicious  harvest  on  the  air;  the  luscious  apple,  pear,  peach, 
plum,  cherry,  tempt  his  ready  hand ;  the  potato,  the  beet,  the  turnip,  the 
tomato,  the  cabbage,  the  pea,  the  cauliflower,  and  a  thousand  other  good 
things,  incite  his  appetite,  whilst  to  this  feast  is  added  the  flesh  of  birds, 
of  oxen,  of  sheep,  of  swine  and  of  fish ;  that  before  the  waving  wheat  and 
corn,  the  flesh  of  other  animals,  the  fruits  and  farinaceous  foods,  the 
running  water,  the  luscious  oyster  and  fish,  etc.,  can  be  transformed  into 
the  refined  and  spiritual  organization  of  man,  it  must  be  thoroughly  pre- 
pared by  the  several  steps  in  the  digestive  process — ^then,  and  only  then, 
is  it  permitted  to  enter  into  and  commingle  with  the  highly  complex, 
nutritious  and  life-sustaining  fluid,  the  blood. 

Great  Value  and  Beauty  of  the  Plate — ^We  can  understand  much  of 
this  wonderful  process.  We  have  looked  into  the  stomach,  watched  its 
peculiar  actions  and  traced  its  various  steps,  from  which  the  scientist  is 


THE  VEBMIFOEM  APPENDIX.  56 

capable,  in  his  laboratory  of  knives,  mortars,  ba'tbs,  chemicals  and  filters, 
of  imitating  many  of  the  operations  of  digestion ;  but  just  at  the  moment 
lie  thinks  himself  most  successful,  he  is  compelled  to  pause.  At  the 
threshold  of  that  "one  step  more,"  "which  Fontenelle  required,  "and  he 
would  surprise  nature  herself,"  he  stops,  and  very  "wisely,  -without  con- 
cealment of  his  designs,  admires,  then  vs'onders,  and  finally  worships  with 
all  the  reverence  of  his  soul. 

Transformation  of  Food  Into  Flesh — How  strange  this  is — the  trans- 
formation of  food  into  human  flesh,  into  human  thoughts!  We  eat  a 
meal;  it  is  composed  of  meat,  bread,  vegetables  and  liquids.  The  more 
solid  part  is  ground  by  the  teeth,  mixed  with  the  difl^erent  juices,  dis- 
solved, changed,  organized  and  is  swept  throiigh  the  body  in  the  circula- 
tion of  the  blood.  Each  organ  seizes  its  own  particular  food  as  it  passes. 
Within  the  cells  of  the  various  tissues  it  is  transformed  into  the  soft,  sen- 
sitive brain,  or  the  hard,  callous  bone ;  here  into  the  nerve  of  sight,  there 
into  gristle  or  tendon ;  here  briny  tears  are  formed,  there  the  bland  saliva ; 
in  the  stomach,  acid  juice;  in  the  skin,  acrid  perspiration;  bile  for  di- 
gestion, oil  for  the  hair,  nails  for  the  fingers,  muscle  for  the  strong  arm 
of  toil,  and  flesh  and  fat  to  give  shape,  form  and  beauty  to  the  face. 

Wonderful  It  All  Is — Wonderful !  Within  us  is  an  Almighty  Archi- 
tect, who  superintends  a  thousand  skilled  laborers,  that  make  a  way  which 
puzzles  human  comprehension;  here  a  fibre  of  muscle;  there  a  filament 
of  nerve;  here  constructing  a  bone;  there  uniting  a  tendon — fashioning 
each  with  the  most  scrupulous  care  and  unerring  nicety.  Without  the 
buzz  of  a  saw,  or  the  sound  of  a  hammer;  without  the  slightest  compres- 
sion, or  the  least  particle  of  noise ;  with  a  regularity,  certainty  and  exact- 
ness, the  glorious  temple  of  man,  in  the  image  of  his  Creator,  goes  up  and 
up,  day  by  day,  skilfully  put  together  by  these  noiseless,  tireless  and 
expert  workmen. 

THE  VERMIFOHM  APPENDIX. 

The  chart  brings  into  view  the  location  and  form  of  that  wonderful 
little  organ  known  as  the  Vermiform  (wormlike)  Appendix  (appendage). 
It  is  an  appendage  of  the  Caecum,  or  lower  bowel.  Its  uses  as  a  bowel 
appendage  have  never  been  established.  It  occurs  in  other  animals  be- 
sides man.  Notwithstanding  its  diminutive  size  and  uselessness  as  an 
organ  it  is  the  seat  of  that  most  paiuful  and  dangerous  disease  called 
Appendicitis,  which  was  formerly  attributed  to  the  presence  of  some  for- 
eign body,  as  a  grape-seed,  lodged  within.  But  it  has  been  found  in- 
flammation of  the  Appendage  may  arise  from,  numerous  other  causes. 


eg  THE   HUMAN   BODY. 

Many  doctors  insist  that  a  surgical  operation — that  is,  the  entire  removal 
of  it  with  knife — is  the  proper  curative  agent,  especially  in  acute  cases. 
But  others  insist  that  the  knife  is  too  frequently  used,  and  that  the  dis- 
ease, if  taken  in  time,  is  quite  surely  curable  by  other  means. 

THE  CniORIS,  TIRETHEA,  VAGINA  AND  HYMEN. 

These  female  organs  show  further  the  perfection  which  anatomical 
plate  printing  has  attained. 

Clitoris. — This  small  organ,  It  will  bo  seen,  is  situated  at  the  upper 
part  of  the  vulva,  or  outside  parts  of  the  female  generative  system,  ami 
is  usually  concealed  by  the  lips  of  the  pudenda.  It  performs  a  function 
during  sexual  intercourse  similar  to  that  performed  by  the  penis  of 
the  male. 

Urethra. — This  highly  useful  organ,  common  to  both  sexes,  is,  as  will 
be  seen  by  the  plate,  the  canal,  or  medium,  by  means  of  which  the  urine 
is  carried  from  the  bladder  to  be  voided.  It  is  a  delicately  lined  organ, 
furnished  with  retentive  valves,  and  therefore  susceptible  to  a  variety 
of  diseases. 

Vagina. — This  word  implies  a  sheath,  and  is  applied  to  the  canal 
which  leads  from  the  uterus  (womb)  to  the  external  organs  of  generation 
in  the  female  sex.  Commonly,  it  implies  such  external  organs,  or  organ, 
as  depicted  in  the  plate. 

Hymen — The  mucous  membrane,  or  virginal  membrane,  at  the  en- 
trance of  the  female  sexxial  organ,  or  vagina. 

BLADDER  AND  PART  OF  VAGINA. 

The  function  and  form  of  the  bladder  are  familiarly  known.  It  is 
the  recipient  of  the  kidney  secretions,  and  contains  them  till  voided 
through  the  urinary  canal.  It  is  of  tough,  elastic  structure,  guarded  at 
the  exit  by  a  contractile  valve,  by  means  of  which  the  urine  can  be  re- 
tained imtil  the  quantity  becomes  excessive.  The  plate  brings  out  the 
entire  urinal  tract,  from  the  bladder  to  the  vagina,  and  presents  a  fine 
and  useful  anatomical  and  physiological  study. 

•WOMB,  OVARIES  AND  VAGINA. 

The  Womb. — The  plate  beautifidly  and  effectively  illustrates  the 
location  and  formation  of  the  womb,  that  wonderful  organ  which  performs 
the  function  of  parturition,  and  which  is  so  constructed  as  to  assist  in  all 


VIEwr  OF  THE  LARGE  BLOOD-VESSELS^  SPLEEN,  KIDNEYS  AND  BLADDER.       57 

the  necessary  efforts  of  birth.  Its  stiiictnre  is  elastic  and  strong,  and  it 
expands  readily  to  accommodate  tlie  gTOwth  of  the  child  (foetus).  While 
this  is  true  exteriorly,  its  inner  parts  are  rather  delicately  lined,  and 
subject  to  a  variety  of  painful  diseases,  generally  designated  as  "Dis- 
eases of  the  Womb." 

The  Ovaries — The  organs  are  situated  contiguously  to  the  womb. 
They  signify  eggs  from  their  shape,  and  they  are  the  parts  which  the 
male  semen  acts  iipon  to  produce  the  phenomenon  of  pregnancy.  Their 
enlargement  by  inflammation  and  their  passage  down  the  fallopian  tubes, 
once  a  month  during  the  middle  period  of  female  life,  produces  the  con- 
dlticm  familiarly  known  as  menstruation.  The  plate  also  affords  another 
view  of  the  vagina. 

NATURAL  POSITION  OF  CHILD  AT  TIME  OF  BIRTH. 

This  beautiful  and  effective  plate  shows  the  natural  position  of  the 
child  at  the  time  of  birth.  It  is  technically  called  the  presentment  of  the 
foetus  for  birth.  Of  presentments  there  are  many  varieties,  whose  study 
is  most  interesting  to  the  obstetrician.  Some  of  them  give  rise  to  very 
difficult  and  dangerous  delivery.  When  the  presentment  is  natural,  as 
in  the  figure,  the  comfort  of  the  mother  is  increased  and  the  doctor's 
anxiety  is  miicli  allayed. 

VIEW   OF  THE  LARGE  BLOOD-VESSELS,  SPLEEN,  KIDNEYS  AND 

BLADDER. 

Blood  Vessels  of  the  Body. — The  blood-vessels  of  the  human  body  con- 
sist of  heart,  arteries,  veins  and  capillaries.  The  heart  and  its  wonders 
we  have  already  referred  to.  In  this  mag-nifieent  chart  we  are  enabled 
to  form  some  idea  of  tlie  larger  blood-vessels.  We  see  the  main  arterial 
tube  of  the  body — the  aorta — from  a  point  where  it  unites  with  the  arch 
of  the  aorta;  and  in  its  descent  do^\'nward  along  the  spinal  cohmin  it 
gives  off  numerous  branches. 

The  Arteries — Opposite  the  fourth  lumbar  vertebra  ii:  is  seen  to  split 
in  two,  and  these  divisions  are  called,  from  their  position,  the  right  and 
left  iliac  arteries.  These  are  seen  to  divide  again  into  the  internal  and 
external  iliac  arteries,  the  fonnor  of  which  is  distributed  to  the  walls  and 
viscera  contained  in  the  pelvis,  then  proceeding  to  the  lower  limbs  after 
sending  two  important  brnnehcs  to  the  abdominal  walls.  The  arch  of  the 
aorta  gives  oft'  the  innominate  artery,  which  divides  into  the  right  carotid 


58  I'llfi  HUMAN  BODY. 

I 

and  right  subclavian  arteries ;  the  left  carotid  and  left  subclavian  spring 
direct  from  the  arch  of  the  aorta.  Each  carotid  arterj'  divides  into  the 
external  and  internal  carotid  arteries,  the  former  being  distributed  to  the 
externa]  parts  of  the  face  and  head;  the  latter  supplies  the  brain  and 
internal  parts  of  the  cranium.  The  subclavian  arteries  supply  the  upper 
extremities  ■with  blo(Kl. 

Intercostal  Arteries — The  intercostal  arteries  and  veins  are  beau- 
tifully ilhistrated  in  the  chart.  The  veins  return  the  blood  to  the  heart. 
The  large  ascending  and  descending  ven;e  cava3  are  seen  in  this  illus- 
tration. 

Meaning  of  Artery — From  the  fact  that  at  death  the  arteries  are 
empty,  the  ancients  believed  them  to  contain  air,  whence  their  name, 
derived  from  aer,  air,  and  tcrco,  I  keep,  which  literally  means,  air  ducts. 

The  Spleen — The  spleen  is  a  spongy  organ,  of  a  livid  color,  oval  in 
figiire  and  situated  in  the  left  upper  part  of  the  abdomen  and  immediately 
behind  the  stomach.  Its  weight  varies  from  four  to  ten  ounces.  It  is 
largely  composed  of  cells,  but  its  function  is  little  understood,  though 
from  its  position  it  is  believed  to  be  in  some  way  useful  to  the  stomach 
during  the  process  of  digestion. 

The  Kidneys — The  kidneys  are  two  glandular  bodies,  having  for 
their  functions  the  secretion  of  urine.  The  form  of  the  kidney  resembles 
a  French  bean ;  its  average  length  being  from,  four  to  four  and  a  half 
inches,  two  inches  in  breadth  and  one  in  thickness.  The  two  kidneys  are 
situated  one  on  each  side  of  the  spine  in  the  Imnbar  region,  opposite  the 
last  two  dorsal  and  two  first  hunbar  vertebra?;  they  are  a  bro\TOish-red 
color  flattened  from  before  backward,  and  gi'ooved  on  the  interior  border 
for  the  reception  of  the  great  vessels. 

The  Veins — The  venal  arteries  are  derived  direct  from  the  aorta; 
and  the  large  veins  terminate  in  the  ascending  large  vein.  On  the  right 
kidney  is  seen  the  super-renal  capsule;  w'hilst  the  left  is  cut  vertically 
into  showing  the  urinifcrous  tubes,  much  convoluted  and  inosculating  with 
each  other.  The  ureter  is  seen  arising  from  the  pelvis  of  the  kidney, 
descending  in  an  oblique  manner  to  the  bladder.  These  wonderful  little 
organs  appear  to  act  as  filters,  and  thus  assist  to  keep  the  vital  stream  of 
life  in  as  pure  and  as  healthy  a  condition  as  possible. 

The  Bladder — The  bladder  is  a  thin,  membranous  bag,  which  sei-vea 
as  a  receiver  of  the  urine  secreted  by  the  kidneys,  and  which  remains 
there  until  voided  by  iirinatiou  through  the  urethra. 

Bone  Sections — The  sections  of  the  bones  show  their  cancellated  ap- 
pearance, which  combines  lightness  with  strength. 


THB   ISnrE   AND   ITS    WONDEES.  69 

CHART   III. 
WONDERS  OF  SIGHT,  HEARING,  TOUCH  AND  LOCOMOTION. 

THE  EYE  AND  ITS  WONDERS. 

Beautiful  Plate  of  the  Eye — The  Ijeautiful  flesh-colored  engraving  at 
the  right-hand  top  corner  of  this  exquisite  composite  anatomical  plate 
gives  a  strikingly  natural,  life-size  representation  of  the  human  eye,  to- 
gether with  its  external  appendages,  the  eyebrows,  the  eyelids,  and  the 
lachrymal  or  tear  glands. 

Muscles  of  the  Eye — On  turning  the  flap  we  see  four  of  the  six  deli- 
cate, hut  withal  strong  muscles  which  not  only  hold  the  eye  firmly  in  its 
bony  orhit,  but  also  move  it  upward  toward  the  canopied  vaults  of  heaven, 
downward  to  view  the  beauties  of  nature  on  earth;  or  sidewise,  to  the 
right  or  left,  spanning  half  the  horizon  at  a  single  glance!  The  next 
illustration  gives  us  a  graphic  and  faithful  delineation  of  the  beautiful 
arrangements  of  the  numerous  curtains,  humors,  lenses,  pigments,  mem- 
branes, nervous  coats  and  blood-vessels  which  enter  into  the  composition 
of  this  remarkable  organ,  each  of  which  is  exquisitely  adapted  to  the 
respective  functions  it  has  to  perform. 

Wonders  of  the  Eye. — The  human  eye  is  one  of  the  most  wonderful, 
as  well  as  delicate,  organs  of  the  body.  It  is  the  window  through  which 
ihe  heart,  mind  and  soul  of  man  shines.  Sorrow  or  joy,  grief  or  mirth, 
pain  or  pleasure,  sunshine  or  shadow  are  reflected  throiigh  this  wondrous 
camera  of  light;  the  human  passions  hold  their  orgies  in  this  window; 
truth  and  love  dance  their  happy  and  joyous  day-dreams  before  its  lu- 
minous curtain;  and  through  it  accurate  delineations  of  every  object 
that  comes  within  its  range  are  carried  to  and  photographed  on  the  brain, 
the  great  art  gallery  of  the  soul !  Can  man,  with  all  of  his  great  and 
scientific  achievements,  conceive  of  anything  in  the  arcana  of  his  accom- 
plishments more  beautiful,  more  wonderful,  or  more  perfect  than  the 
human  eye! 

THE  EAR  AND  ITS  WONDERS. 

The  External  Ear — The  organ  of  hearing  consists  of  three  parts :  the 
external  car,  the  middle  ear  or  tympanum,  and  the  internal  ear  or  laby- 
rinth. The  external  part  of  the  ear  re]iresentcd  in  tliis  coloi-ed  engraving 
19  very  realistic  of  that  essential  aj)pendage  to  this  important  special  organ 


60  TITE    rtUMAK    BOOT. 

of  sense  in  man.  It  consists  of  an  expanded  sheet  of  cartilage,  folded  in 
true  trumpet  fashion,  for  collecting  the  sound  Traves  and  conveying  them 
to  the  external  meatus  or  mouth  of  the  auditory  canal. 

The  Ear  Drum. — On  the  back  of  this  Hap  is  seen  a  strikingly  natural 
representation  of  the  middle  ear,  the  tympanum  or  drum,  as  it  is  fre- 
quently called.  From  the  bottom  of  the  tympanum  is  observed  the  Eu- 
stachian tube,  through  which  is  conveyed  air  from  the  pharynx  to  tha 
middle  ear.  Across  this  chamber  is  seen  stretched  three  very  tiny,  singular 
bones,  which,  from  their  shape,  are  called  the  hammer,  the  anvil  and 
the  stapes.  These  delicate  bones  are  connectctl  together,  one  by  ball  and 
socket  joint,  the  other  by  a  hinge-joint  and  by  ligaments,  and  are  moved 
"by  small  muscles ;  they  serve  to  convey  the  "wave  sounds  across  the  tym- 
panum cavity  to  the  internal  ear. 

Show  of  Ear  Canals — The  semicircular  canals,  and  the  cochlea,  so 
named  from  its  resemblance  to  a  snail's  shell,  are  also  typically  shown. 
In  the  next  colored  illustration  we  observe  a  graphic  and  truthful  view 
of  the  delicate  internal  arrangement  and  mechanism  of  the  internal  part 
of  the  organ  of  hearing.  Here  we  observe  the  winding  stair  of  the  coch- 
lea, over  the  surface  of  which  the  delicate  fibrils  of  the  auditory  nerve 
expand,  and  the  minute  fibres  of  Corti,  called  from  their  discoverer,  are 
seen  arranged  with  geometrical  precision,  the  longest  at  the  bottom  and 
the  shortest  at  the  top. 

Wonders  of  the  Spiral  Plate. — If  this  curious  and  artistic  spiral  plate, 
which  is  seen  to  wind  two  and  one-half  times  round,  could  be  unrolled 
and  made  to  stand  in  an  upright  position,  it  would  make  a  beautiful  micro- 
scopic harp,  not  of  a  thousand  strings,  but  of  three  thousand  strings,  and 
if  it  were  possible  to  strike  these  delicate  infinitesimal  cords  as  we  can 
the  keyboard  of  an  organ  or  piano,  every  conceivable  variety  of  tone  that 
the  ear  can  distinguish  would  be  produced  and  conveyed  to  the  brain 
as  the  product  of  sound. 

THE  HAND;  ITS  MECHAOTSM  AND  WONDEEFTJL  ENDOWMENTS. 

"Engraving  of  the  Hand. — To  tell  one  that  this  exquisite  colored  en- 
graving represents  a  human  hand  seems  almost  like  questioning  his  sanity. 
Yet  such  it  is ;  but  how  few  there  are  who  can  give  an  intelligent  account 
of  the  hand,  describe  its  beautiful  arrangements  and  complex  mechanism, 
or  tell  of  its  wonderful  endowments.  Small  in  compass,  compact  in  struc- 
ture, yet  so  skilfully  ai-ranged  are  its  blood-vessels  and  nerves,  that  they 
form  a  complete  net-work  over  its  surface.     So  minute  are  they  in  their 


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THH    HAJTD;    its  TtTECKANTSM    AlTD    ■WOND'EKTTTTj    BTTDOWMEirra.  61 

distribution  that  the  point  of  the  finest  needle  cannot  penetrate  any  pari 
of  the  hand  without  piercing  quite  a  number  of  them.  The  hand  is  the 
great  organ  of  touch  and  prehension,  and  the  instnmient  which  distin- 
guishes man  in  the  large  class  of  mammals,  since  he  is  the  only  animal 
which  possesses  two  perfect  and  complete  hands. 

Bony  Frame  of  the  Hand — On  turning  over  this  flap  we  behold  the 
bony  frame-work  of  this  wonderful  organ.  It  is  seen  to  consist  of  a  num- 
ber of  bones,  so  exquisitely  arranged  as  to  combine  the  greatest  possible 
degree  of  flexibility  and  strength. 

Palm  of  the  Hand — Below  this  is  given  an  elegant,  and  at  the  same 
time  a  true  and  correct  view  of  the  muscular  arrangement  of  the  palm 
of  the  hand  and  fingers.  Over  the  wrist  is  seen  the  annular  ligament,  that 
thin,  tough,  strong  sheath,  which  binds  the  muscular  cords  and  holds 
them  firmly  in  place.  Thus  in  these  three  anatomical  charts  have  we 
depicted  the  perfection  of  the  human  hand. 

Powers  of  the  Hand. — And  how  varied  and  useful  are  its  endow- 
ments !  How  wondrously  adapted  to  the  uses  to  which  it  is  daily  applied  I 
Its  elegance  of  outline,  delicacy  of  mould  and  beauty  of  color  has  ever 
made  it  the  attractive  study  of  the  artist ;  whilst  its  elasticity,  flexibility 
and  strength,  combined  with  its  delicate  and  exquisite  niobility,  and  per- 
fect adaptation  as  an  organ  of  prehension,  have  led  many  philosophers  to 
attribute  man's  high  and  gi-aceful  suiDeriority  even  more  to  the  hand 
than  to  the  mind.  Glowing  thoughts  are  penned  upon  the  pages  of  his- 
tory by  means  of  tlie  hand ;  it  wields  the  artist's  pencil  and  brush,  and 
makes  the  bare  canvas  an  attractive  and  valuable  work  of  art ;  now  it 
strikes  the  keyboard  of  the  piano  with  so  delicate  a  toiich  that  low,  sweet, 
plaintive  strains  of  music  are  brought  forth;  now  the  force  of  the  blow 
is  much  greater  and  firmer,  and  louder  and  louder  and  more  thrilling 
the  musical  strains. 

Skill  of  the  Hand — The  farmer's  toil,  the  housewife's  task,  the  dress- 
maker's deftness.,  the  mechanic's  skill,  are  all  accomplished  by  the  human 
hand.  How  constantly  this  little  instrument  aids  us  in  expressing  our 
feelings.  It  is  the  orator's  chief  aid  in  giving  expression  to  his  lofty 
strains  of  eloquence,  or  emphasizing  his  pathetic  appeals. 

Various  Uses  of  -the  Hand — With  the  hand  we  affirm  or  reject  a 
proposition  with  more  force  than  with  the  tongue.  It  is  the  first  to  greet, 
and  the  last  to  bid  our  friends  good-bye.  We  use  it  to  express  our  joy 
and  pleasure,  or  to  give  vent  to  our  fear  and  horror.  In  the  hour  of  peril 
we  employ  it  in  powerful  supplication  to  Him  to  whom  we  look  for  suc- 
cor and  help,  and  it  adds  force  and  power  to  the  appeals  of  suffering,  of 


62  THE   nUMAH   BODY. 

sorrow  and  of  woo.  It  bestows  its  loving  caresses  on  the  downy  cheek  of 
the  baby,  invokes  tlie  blessings  of  Heaven,  pleads  for  mercy,  or  hurls 
curses  on  our  enemies.  Indeed,  we  do  not  always  seem  to  realize  how 
many  notes  in  the  tune  of  human  life  the  hand  of  man  is  made  to  play. 
Its  beauties,  its  perfect  adaptability,  it  varied  endowments,  and  the  dif- 
ferent uses  to  which  it  is  applied,  are  almost  beyond  our  thouglits,  and  ho 
who  is  deprived  of  this  useful  member  sustains  a  loss  that  none  can  esti- 
mate, nor  the  wealth  of  Croesus  compensate. 

THE  FOOT;  ITS  MECHAIHSM  AND  ITS  WONDERFTIL  ENDOWMENTS. 

Arrangement  and  Uses  of  the  Foot. — In  this  exquisite  colored  engrav- 
ing is  represented  the  human  foot,  the  organ  by  which  we  stand,  walk 
or  run.  Look  at  it  carefully,  aye,  critically,  and  see  if  you  can  duplicate 
it  in  the  whole  range  of  man's  achievements !  The  general  arrangement 
of  the  bony  frame-work  of  the  foot,  as  seen  in  this  illustration,  is  strik- 
ingly like  that  of  the  hand.  The  graceful  arch  of  the  foot,  composed  by 
the  tarsal  and  metatarsal  bones,  is  firmly  joined  together  by  a  thick 
layer  of  cartilaginous  structure,  not  only  preventing  a  liability  to  dis- 
placement, but  giving  to  it  an  elasticity,  sprightliness  and  strength  which 
could  never  be  attained  by  a  single  flat  bone.  In  the  next  colored  illus- 
tration we  have  a  section  of  the  foot,  showing  its  architectural  dignity 
and  perfection.  On  its  under  or  plantar  surface  are  seen  stretching  from 
the  heel  forward  toward  the  toes  a  number  of  ligaments,  the  principal 
one  of  which  is  the  plantar  ligament,  and  possesses  great  strength  and 
elasticity. 

The  Toes — The  toes  are  observed  to  lie  straight  forward  in  a  line 
■with  the  general  contour  of  the  foot.  This  is  their  natural  position.  The 
beautiful  outline  of  the  natural  foot,  as  here  represented  in  these  several 
different  views,  the  gracefid  arch  of  the  instep,  the  elegance  of  its  form, 
its  marvelous  elasticity  and  strength,  all  combine  to  make  the  foot  not 
only  of  great  perfection  and  beauty,  but  admirably  fit  it  for  the  mani- 
fold duties  it  is  called  upon  to  perform.  ]\lan,  in  his  diversified  labors 
and  varied  trials  throughout  life,  is  sometimes  obliged  to  walk,  run,  jump, 
leap,  climb,  stand  erect,  lean  forward,  etc.,  and  he  depends  upon  the 
foot  to  maintain  his  equilibrium  in  the  performance  of  these  several 
duties. 

Beauty  and  Streng:th  of  the  Foot. — Not  only  does  the  foot,  too,  fre- 
quently sustain  heavy  weights,  but  it  must  carry  them  as  well.  It  like- 
wise affords  a  firm  support.     Were  it  not  for  this  beautiful  mechanism. 


TH^  leg;  its  MECnANIRM  ANT?  WONDERFUL  ENDOWMENTS.  63 

€he  constant  jarring  and  concussion  which  would  be  experienced  in  tb^ 
act  of  walking  would  inevitably  destroy  those  delicate  organs,  the  brain 
and  spinal  cord,  and  death  would  immediately  follow.  How  few  persons 
in  civilized  nations  have  perfectly  natural  feet!  The  beauty  and  utility 
of  the  human  foot  is  marred ;  its  movements  are  impeded  by  encasement 
in  unnatural  boots  and  shoes;  these,  instead  of  conforming  to  the  form 
and  shape  of  the  foot,  make  the  foot  adapt  itseK  to  them.  The  conse- 
quence is  corns,  bunions,  cross  toes,  ingrowing  toe-nails,  large  joints, 
and  a  number  of  other  evils  from  which  so  many  suffer  at  the  present  day. 


iTHE  lEQ;  ITS  MECHANISM  AND   ITS  "WONDERFITL  ENDOWMENTS. 

Leg  Muscles — In  every  part  of  tlie  human  frame  there  is  witnessed 
iample  evidence  of  design,  beauty  of  architecture,  great  skill,  finished 
workmanship,  and  a  perfec';  adaptability  to  the  duties  to  be  performed. 
This  fact  is  strikingly  illustrated  in  the  beautifully  executed  colored  plate 
to  which  attention  is  now  drawn,  showing,  as  it  does,  at  a  glance,  the 
thick,  strong,  muscular  instruments  employed  and  the  manifold  intricacies 
involved  in  the  act  of  human  locomotion.  This  exquisitely  artistic  anat- 
omical plate  represents  a  front  view  of  the  thigh,  leg  and  foot,  and  of 
the  fifty-four  fleshy  levers  which,  give  form,  shape,  symmetry,  strength 
and  mobility  to  this  useful  member  of  the  body.  Quite  a  number  of  the 
most  important  are  seen  exposed  to  view,  after  the  skin  and  fatty  tissues 
have  been  removed.  We  are  deeply  impressed  with  their  large  size  and 
great  strength,  both  of  which  correspond  with  the  requirements  demanded 
in  the  varied  work  which  the  leg  is  called  upon  to  perform. 

Use  of  the  leg  Muscles — The  muscles  observed  in  this  plate  are  the 
principal  instruments  for  carrying  out  the  behests  of  the  will  in  the  acts 
of  walking,  running,  leaping,  climbing,  and  the  gi'aceful,  gliding  motions 
of  the  entrancing  and  captivating  waltz;  and  although  we  see  a  compli- 
cated piece  of  machinery,  yet  there  is  perfect  order.  Harmony,  prompti- 
tude and  exactness  prevail,  not  only  in  the  skilful  manner  in  which  they 
ere  individually  and  collectively  arranged,  but  in  the  action  of  the  dif- 
ferent muscles,  each  one  of  which  performs  its  duty  either  independently 
of,  or  in  connection  with,  its  fellow  lever,  and  that,  too,  without  inter- 
fering in  the  slightest  degree  witli  the  functions  of  the  others. 

Muscular  levers. — These  gi'cat  muscular  levers  bend  the  body  for- 
ward on  tlie  thigh,  and  bring  the  legs  inward  toward  each  other,  besidea 
moving  the  whole  body  tq  and  fro  when  walking,  etc.     The  long,  narrow- 


64  THE    HUMAN    BODY. 

muscle,  seen  ruiming  obliquely  across  the  thigli,  is  tlie  Sartorius  iniiscle, 
so-called  from  the  fact  that  it  crosses  the  legs  for  the  sartorial  (tailor's) 
posture.     It  is  the  longest  muscle  in  the  body. 

The  Knee-Pan. — The  patella  or  kuee-pan  is  seen  held  firmly  in  posi- 
tion, giving  greater  strength  and  security  to  this  important  joint.  Around 
the  ankle  is  observed  the  annular  ligament,  binding  the  long  silvery 
thongs  or  tendons  of  the  muscles  of  the  legs,  thus  preventing  their  dis- 
placement. It  also  affords  security  and  strength  to  the  ankle  joint,  though 
not  interfering  with  its  elasticity  and  motion.  The  foot  shows  ua  the 
natural  jwsition  and  shape  in  which  the  toes  should  be  when  encased  in 
a  boot  or  shoe. 

Thigh  and  leg  Bones. — On  turning  the  flap  we  see  the  bones  of  the 
thigh  and  leg,  and  a  front  view  of  the  bones  of  the  anlde  joint  and  foot. 
As  was  to  be  naturally  expected,  we  here  find  the  largest,  the  longest  and 
strongest  bone  in  the  human  body,  since,  with  every  step  taken,  it  has 
to  bear  the  entire  weight  of  that  wonderfully  and  fearfully  constructed 
body,  and  support  whatever  additional  burdens  or  weights  one  is  called 
upon  to  impose  in  the  course  of  his  daily  labors.  The  bone  is  observed 
to  be  compressed,  somewhat  cylindrical  in  shape,  but  expanded  at  both 
ends,  thus  giving  it  the  greatest  possible  degree  of  strength.  At  its  lower 
end  it  articulates,  and  forms  a  hinge-joint  with  the  knee,  the  strength 
and  protection  of  which  is  further  secured  by  the  shape  and  position 
of  the  knee-pan. 

The  Shin  Bone. — The  tibia  or  shin  bone  is  also  a  very  large,  strong, 
triangidar-shaped  bone,  enlarged  at  both  ends;  the  lower  end,  however, 
where  it  articulates  and  forms  a  hinge-joint  with  the  foot,  is  larger  and 
more  prominent  tban  the  upper  end.  And  as  if  this  bone  was  not  suiB- 
ciently  strong  enough  in  itself  to  bear  the  weight  of  the  body,  our  Cre- 
ator, with  that  boundless  wisdom  and  forethought  which  everywhere  in 
the  human  frame  we  see  revealed,  strengthens  the  legs  by  an  additional 
bone,  which  is  seen  running  on  the  outer  side  of  the  shin  bone,  and  to 
which  it  is  firmly  bound  at  both  ends. 

The  Fibula — Xot  only  does  this  second  bone — ^the  fibula — ^give  addi- 
tional strength  and  supjjort  to  the  leg  proper,  but  it  likewise  increases 
the  bony  area  or  surface  of  the  leg,  to  which  its  powerful  muscular  levers 
are  attached. 

The  Sciatic  Nerve. — The  large  sciatic  nerve,  its  position,  course  and 
distribution,  is  gi-aphically  outlined,  and  as  we  look  upon  this  white,  sen- 
sitive cord,  we  are  deeply  impressed  with  the  force  and  truth  of  what 
Shakespeare  makes  one  of  his  characters,  Timun,  say: 


THE  LEG  ;  ITS  MECHANISM  AND  WONDEET'UI,  ENDOWMENTS. 


Tlie  cold  SCIATICA 


05 


Cripples  our  senators,  that  their  limbs  may  halt 
As  lamely  as  their  manners." 

Muscles  of  Thigli  and  Leg — Turning  to  the  next  colored  illustration, 
we  have  a  graphic  and  faithful  view  of  the  deeper  muscidar  arrangements 
of  the  thigh  and  leg,  together  with  a  striking  description  of  tlie  nervous 
supply  of  the  lower  extremity.  These  beautiful,  silvery  threads  are  the 
wires  which  carry  the  behests  of  the  will  to  the  muscular  levers,  aud 
whose  commands  the  muscles  promjDtly  obey;  and  give  to  the  leg  its 
wonderful  and  diversified  endowments.  To  stand  erect  is  a  very  difficult 
and  complex  act,  and  the  process  of  walking  is  a  no  less  difficult  or 
complex  function.  Few  persons  ever  realize  the  peril  involved  in  walking, 
and  it  has  only  become  safe  by  constant  practice. 

Art  of  Walking — Walking  requires  the  nicest  adjustment,  prompt 
action,  and  the  finest  calculations  to  maintain  the  dignity,  proper  attitude, 
equipoise  and  balance  of  the  body.  This  is  well  illustrated  when  one  runs 
up  against  any  obstacle  in  the  dark.  We  observe  then  with  what  head- 
Jong  force  the  body  is  propelled  forward.  In  walking  the  first  thing  that 
occurs  is  the  inclining  of  the  body  forward;  the  foot  is  then  gradually 
raised  upon  the  toes,  and  brought  from  a  horizontal  position  into  an 
almost  vertical  one;  at  the  same  time  the  knee,  which  was  at  first  con- 
Eiderably  bent,  straightens  out  by  the  advancing  forward  movement. 
Every  part  of  the  leg  and  thigh  has  changed  its  position  except  the  toes ; 
that  part  farthest  from  the  toes  the  most  of  all ;  and  gradually  diminishing 
in  geometrical  proportions  downward. 

How  We  Walk — The  foot  is  then  raised  from  the  ground  and  swung 
forward  in  true  pendulum  fashion.  The  leg  in  so  doing  becomes  flexed 
at  the  knee-joint,  and  considerably  shorter,  and  the  whole  weight  of 
the  body  is  transferred  to  and  supported  by  the  leg  and  foot,  which  is 
planted  firmly  on  the  ground.  The  leg  and  the  foot  which  was  swinging 
in  the  air  is  now  brought  down  to  the  ground,  the  muscles  passing 
through  changes  just  the  reverse  of  those  employed  in  raising  it.  Plant- 
ing this  foot  firmly  on  the  ground,  to  prevent  the  body  from  falling,  we 
raise  the  other  foot,  swing  it  forward,  the  leg  describing  the  same  move- 
ments as  before,  repeating  the  process  alternately  with  each  leg.  These 
movements  constitute  the  act  of  walking;  the  complexity  of  which  is 
fully  illustrated  by  the  complicated  machinery  employed  for  its  perform- 
ance, as  we  have  seen  in  the  beautiful  plates  showing  the  wonderful  and 
skilful  arrangements  of  the  bones  and  muscles  of  the  leg. 


66  ANATOMY  AND  PHYSIOLOGY. 

Grace  and  Ease  in  Walking. — lu  the  several  beautiful  anatouiical 
charts  illustrating  tlie  bony,  muscular  and  internal  mechanism  of  the 
human  frame  wo  have  been  consciously  awakened  to  its  complexity;  we 
have  been  forcibly  impressed  at  the  amazing  skill  and  wisdom  displayed 
in  its  nuirvelous  arrangement,  and  at  the  general  order,  system,  harmony 
and  perfection  which  everywhere  prevails  throughout  the  diversified  con- 
trivance of  the  body.  But  its  wonders  do  not  stop  there.  The  gi-aceful 
motion,  the  case  with  which  we  walk,  run,  leap,  dance,  etc.,  demonstrate 
with  what  astonishing  rapidity  the  different  muscles  concerned  in  those 
movements  contract  and  obey  the  impulse  of  the  Avill. 

The  Voice. — The  voice  may  utter  one  thousand  five  himdrcd  letters 
in  a  minute,  yet  the  articulation  of  each  of  those  sounds  requires  a  dif- 
ferent and  distinct  position  of  the  vocal  organs,  tlie  muscles  of  which 
move  with  surprising  celerity  and  swiftness. 

Deftness  of  the  Fingers. — In  umsic  we  train  the  muscles  of  the  fingers 
until  tliey  glide  over  the  keyboard  of  the  piano  with  dexterity  and  pre- 
cision, and  perform  the  most  simple  and  delightfully  exquisite  music 
and  on  to  the  grand,  difficult  and  complex  passage  of  operatic  harmony. 
The  mind  of  the  skilful  and  professional  violinist  is  upon  the  music  which 
his  riglit  hand  is  executing  by  the  varied  movements  of  the  bow,  yet  the 
muscles  of  his  left  hand  and  fingers  are  deftly  engaged  in  determining 
the  length  of  the  space  on  the  strings,  the  character  and  duration  of 
each  note ;  and  so  rapidly,  carefully,  aye,  even  unconsciously  are  these 
complex  movements  niiide,  that  not  a  false  note  is  heard,  though  the 
variation  of  a  single  hair's  breadth  would  cause  a  discord,  and  thus  spoil 
the  pleasing  effect  of  the  mlisic,  and  destroy  the  attractiveness  of  its 
harmony. 

Muscle  Development — The  bleep  muscle  in  the  arm  of  the  blacksmith 
may  grow  strong,  hard,  firm,  and  as  solid  almost  as  a  club;  the  legs  of 
the  pedestrian  may  become  large  and  well  developed ;  the  hand  of  a  prize 
fighter  may  be  trained  to  strike  a  stumiing  blow  ^vith  the  force  of  a  sledge 
hanmier;  while  the  penman  can  describe  the  most  beautiful  curves,  the 
engraver  trace  lines  so  delicate  and  fine  as  to  be  invisible  to  the  naked 
eye,  and  the  fingers  of  the  blind  acquire  a  delicacy  of  touch  that  almost 
compensates  for  the  missing  sense.  Thus  there  are  few  conceptions  of 
tlie  designing  mind  which  the  muscular  system  of  man  cannot  be  made 
to  execute  and  perfoi-m. 


INDEX  TO  BOOK  II 


Book  II  treats  of  Anatomy  and  Physiology,  a 
knowledge  of  which  is  essential  to  a  proper  study  of 
disease. 

SUBJECTS  OF  THE  TEXT 


Abdomen,  The 93 

Abdominal  Aorta   1 10 

Absorption    104 

Air  Vesicles   116 

Anterior  Tibial  Artery  113 

Aorta,  The    108 

Aorta,  Abdominal    no 

Aorta,  Thoracic    109 

Apparatus,  Digestive   98 

Apparatus,  Respiratory  lij 

Arm  Bone  83 

Arrangement  of  the  Skin  74 

Arteries,  The   108 

Arteries,  Coronary   108 

Artery,   Femoral    112 

Arteries,  Function  of   108 

Artery,   Popliteal    113 

Artery,  Radial  109 

Artery,   Pulmonary    113 

Artery,  Ulnar    log 

Attachments,  Muscle   88 

Atlas,  The  80 

Auricle,  Left   107 

Auricle,   Right    106 

Axillary  Vein  115 

Back,  Muscles  of   91 

Biceps,  The   93 

Blood   104 

Blood,  Composition  of   104 

Blood,  Course  of 106 

Blood,  Oxygenized   116 

Bodily  Organs   jZ 

Body,  Framework  of 77 

Bone,  Arm    83 

Bone,  Compact 75 

Bone,  Frontal   80 

Bone,  Hyoid  82 

Bone,  Sphenoid   81 


Bone  Structure  75 

Bone,    Temporal    81 

Bone,  Thigh   8S 

Bones,  Facial    81 

Bones,  Flat   79 

Bones  of  Foot   86 

Bones  of  Leg  85 

Bones,  Number  of   79 

Bones,  'Short   78 

Bones,  Side  and  Top  of  Skull   80 

Bones,   Skull   80 

Bones,  The   yy 

Bones,  Tissue. of  75 

Brain,  Divisions  of   118 

Brain,  Nerves  of  119 

Brain,  The   117 

Brain,  Weight  of   118 

Breast  Muscles   93 

Breathing    ii6 

Calf,  Muscles  of   97 

Cardiacs    108 

Cells,  Forms  of  y^ 

Cells,  Size  of  y^ 

Cerebellum,  The    ; . . .  1 19 

Cerebrum,  The  118 

Cervical  Plexus  121 

Chest,  The   82 

Chewing,  Muscles  of  90 

Cillia  of  Windpipe   74 

Circulatory  Apparatus    105 

Circulatory  System  104 

Columnar  Epithelium   74 

Column,    Spinal    79 

Common  Iliacs  no 

Compact  Bone  75 

Composition  of  Blood  104 

Connective   Tissue    75 

Cord,  Spinal  120 


67 


68 


INDEX  TO  BOOK  n. 


Coronary  Arteries  lo8 

Corpuscles    los 

Course  of  Blood   io6 

Deltoid  Muscle   93 

Diaphragm,  The    92 

Digestive  Apparatus    98 

Division  of  the  Brain   118 

Divisions,  Heart   105 

Dorsalis  Pedis   113 

Duodenum    100 

Endothelium    75 

Epithelium    74 

Epithelium,  Columnar   74 

Epithelium,   Glandular    74 

Extensors,  Radial   95 

External   Iliac    iii 

Extremity,    Lovirer    8$ 

Extremity,   Upper    82 

Face,  Muscles  of  90 

Facial  Bones    81 

Femoral  Artery    112 

Femoral  Vein    115 

Femur,   The    87 

Fibrous  Tissue  76 

Fifth   Nerve    119 

Flat  Bones  79 

Flexors    95 

Foot  Bones   86 

Foot,  Sole  of  98 

Forearm,   The    83 

Forearm,  Muscles  of   94 

Forms  of  Cells  73 

Framework  of  Body   77 

Frontal  Bone  80 

Function  of  Arteries   108 

Function  of  Nerves   116 

Function,  Vein   113 

Gastric  Juice   100 

Glandular  Epithelium   74 

Gristle,  Structure  of   76 

Gristle,  Use  of  76 

Gullet,  The   99 

Hand,  The   84 

Heart,  The    105 

Heart   Division    loS 

Heart  Sounds   loS 

Hip  Socket   85 

Hyoid  Bone    82 

Iliacs,  Common   no 

Iliacs,  External   1 1 1 

Inner  Trunks   122 


Innominate  Veins   1 13 

Internal   Juglar    1 13 

Intestine,  Small   100 

Intestine,    Large    loi 

Jaw,  Muscles  of   91 

Joints,  The    86 

Jugular,  Internal   113 

Jugular   Vein    113 

Juice,  Gastric   100 

Knee-Pan   (Knee-Cap)    85 

Lacteals    ". 104 

Large   Intestine    loi 

Larynx     115 

Lett  Auricle   107 

Left   Ventricle    107 

Leg  Bones    85 

Ligaments  of  the  Vertebrae  80 

Liver,  The   102 

Lower  Extremity,  The   85 

Lumbar  Nerves   122 

Lungs,  The   115 

Lung   Lobes    116 

Lung  Membrane    116 

Median   Nerve    122 

^Median    Vein 114 

Medulla  Oblongata  119 

Membranes,   Lung    116 

Mouth,  The   98 

Muscle  Attachments    88 

Muscle,  Deltoid   93 

Muscle,  The  Tailor's   95 

Muscles  of  the  Back  91 

Muscles  of  the  Breast  93 

]\Iuscles  of  the  Calf 97 

Muscles  of  Chewing  90 

Muscles  of  the  Face  go 

Muscles  of  the  Forearm  94 

Muscles  of  the  Jaw  91 

Muscles  of  the  Lower  Extremity   ....  95 

Muscles,  The    87 

Muscles,   Thigh    95 

Muscles,  Thorax   92 

Muscular  Tissue    77 

Nerve,  Median  122 

Nerves  of  Brain   1 19 

Nerves,  Function  of  116 

Nerves,  Lumbar   122 

Nerves,    Sacral    122 

Nerves,  'Spinal    121,  122 

Nervous   System   I16 

Nervous  Tissue 76 


INDEX  TO  BOOK  II. 


69 


Number  of  Bones   79 

Organs,  Bodily   73 

Outer  Trunks  122 

Oxygenized   Blood    1 16 

Pancreas,  The   102 

Pedis,  Dorsalis   113 

Periosteum   75 

Peritoneum    103 

Pharynx    99 

Plantars    113 

Plexus,   Cervical    121 

Popliteal   Artery    113 

Portal  Vein   115 

Posterior   Tibial    113 

Protoplasm    yi 

Pulmonary  Artery    113 

Pulmonary  Veins   nS 

Pulsation    108 

Radial  Artery  109 

Radial    Extensors    95 

Radial  Vein   114 

Radius,  The    84 

Respiratory   Apparatus    115 

Ribs,  The   82 

Right  Auricle   106 

Right  Ventricle    106 

Sacral    Nerves    122 

Sacrum,  The    80 

Saphenous  Vein   115 

Scapula,  The  83 

Short  Bones   78 

Shoulder,  Socket  of  83 

Shoulders,  The   82 

Side  Bones  of  the  Skull  80 

Size  of  Cells    y2i 

Skin  Arrangement   74 

Skull,  Bones  of   80 

Skull,   The    80 

Small  Intestine  100 

Socket,  Hip   85 

Socket  of  the  Shoulder  83 

Sole  of  the  Foot  98 

Sounds,  Heart   108 

Sphenoid  Bone   81 

Spinal  Column   79 

Spinal  Cord   120 

Spinal   Nerves   121,  122 

Spinal   Vertebrae    79 

Spine,  The  79 

Stomach,  The  99 

Stomach,  Walls  of  99 

Structure,  Bone  » .  75 


Structure  of  Gristle    76 

Structure  of  Veins   113 

Subclavian     108 

Sweetbread    102 

System,  Nervous   116 

System,  Circulatory    104 

Tailor's  Muscle   95 

Temporal  Bone   81 

Thigh    Bone    85 

Thigh  Muscle  . . . ; 95 

Thoracic   Aorta    109 

Thorax,  Muscles  of   92 

Thorax,  The  82 

Tibial  Artery,  Anterior  113 

Tibial  Artery,  Posterior   113 

Tissue  of  Bones  75 

Tissue,  Connective    75 

Tissue,  Fibrous   76 

Tissue,   Muscular    77 

Tissue,   Nervous    76 

Tongue,   The   99 

Top  Bones  of  the  Skull   80 

Triceps,  The   94 

Trunks,  Inner  and  Outer    122 

Ulnar  Artery   log 

Upper  Extremity   82 

Upper  Extremity,  Veins  of  1 13 

Use  of  Gristle   76 

Veins,   The    1 13 

Vein,  Axillary    115 

Vein,   Femoral    115 

Vein   Function    113 

Vein,   Innominate    113 

Vein,   Jugular    113 

Vein,   Median   1 14 

Vein,  Portal   US 

Vein,   Pulmonary   115 

Vein,    Radial    114 

Vein,  Saphenous   US 

Vein  Structure  113 

Veins  of  Upper  Extremity   113 

Ventricle,   Right    106 

Ventricle,  Left   107 

Vertebrae,  Ligaments  of   80 

Vertebrs,  Spinal   79 

Vesicles,   Air    116 

Walls  of  the  Stomach   99 

Weight  of  the  Brain   Ii3 

Windpipe,  Cilia  of 74. 

Windpipe,  The  115 

Wrist,  The   84 


;70 


INDEX  TO  BOOK  U. 


LIST  OF  ILLUSTRATIONS 


Aoromio-Clavicular  and  Shoulder 

Joints    88 

Alimentary     Canal     from     Throat     to 

Anus    loi 

Ankle  Joint.  Section  of 88 

Arm    Uoncs 83,84 

Atlas,  The,  or  First  Cervical  Vertebras,  So 

Blood    Corpuscles,    Magnified 105 

Bone,  Section  of.  Magnified 75 

Bones  of  the  Hand    (Carpus) 84 

Brain   and   Cord 121 

Buttock  and  Back  of  Thigh 124 

Carpus,  or  Bones  of  the  Hand 84 

Cartilage,  Section  of.  Magnified 76 

Cervical  Cord,  Section  of 122 

Cihated   Epithelial   Tissue 74 

Corpuscles  of  Blood,  Magnified 105 

Dorsel  Vertebrae,  Section  of. 79 

Epithelial  Tissue , 74 

Epithelial    Tissue,    Ciliated 74 

Epithelium,  Columnar   74 

Face,  Nerves  of    118 

Fat,  Section  of,  Magnified 76 

Femur,  or  Thigh  Bone 87 

Fibula,  or  Minor  Shin  Bone 87 

Foot  Bones   (Tarsus  and  Metatarsus)   87 

Gland,  Simple   74 

Glands,  Salivary  98 

Hand,  Bones  of 84 

Head,    Arteries    of 109 

Heart  and  Lungs,   Sectional  View....  106 
Heart,     Showing    Auricles    and    Ven- 
tricles     107 

Hip  Joint,  Socket  and  Ligaments 88 

Htim.an  Skeleton   (full  page) 78 

Humcru!;,  or  Large  Bone  of  the  Arm,  S3 
Liver,   The,   Showing  Lobes   and   Bile 

Duct    loj 

Lumbar  Vertebrae,  Section  of 70 


Lungs  and  Heart,  Sectional  View  of..  106 
Lymphatic     Vessels     of     the     Human 

Body    103 

Lymphatics   , 104 

Muscle,  Non-striated  77 

Muscle,  Striated   77 

Muscles  Back  of  the  Thigh 97 

Muscles  of  Back  of  Forearm 94 

Muscles  of  Front  of  Forearm 94 

Muscles  of  Front  of  the  Leg 97 

]\Iuscles  of  the  Back 92 

Muscles  of  the  Body,  Back  View 89 

Muscles  of  the  Body,  Front  View go 

Muscles  of  the  Chest 93 

Muscles  of  Face,  Jaw  and  Neck 91 

Nerve  Cells,  Group  of.  Magnified 76 

Nerves,  Magnified  and  Described 77 

Nerves  of  the   Thigh 96 

Nerves   of  the   Thigh 123 

Nerves  of  the  Face  and  Scalp 118 

Nerves — iNinth,  Tenth   and  Eleventh,   120 

Nerve,    Fifth    119 

Ninth,  Tenth  and  Eleventh  Nerves  of 

Organs  of  Sense  120 

Non-striated   Muscles    77 

Pavcm-ent  Epithelial  Tissue 74 

Pelvis  of  the  Male 86 

Peritoneum,  Showing  all  Involved  Or- 
gans     102 

Racemose    Gland,    The 74 

Radius,  or  Bone  of  the  Forearm 84 

Ribs,  The,  Showing  Thorax 82 

Salivary  Glands 98 

Scalp,  Nerves  of 118 

Scapula,  or  Back  of  the  Shoulder....  83 

Sectional  View  of  Base  of  Brain 117 

Section  of  Bone  Magnified 7$ 

Section  of  Servical  Cord 122 

Section  of  the  Spinal  Vertebrae 79 


INDEX  TO  BOOK  II. 


71 


Semilunar  Valves  of  the  Heart io8 

Shoulder   Joints    88 

Simple  Glandular  Epithelium  74 

Skeleton   (full  page)    78 

Skull,  Front  View  of 81 

Skull,  View  of  the  Base  of  81 

Spinal  Column,  Complete  Outline  of..   79 

Spinal   Cord    121 

Stomach,  The 100 

Stomach  Tubule,  Showing  Fundus  and 

Muscular  Coat  100 

Striated  Muscle,  Sections  of •;■; 

Thigh,  Arteries  of   112 


Thigh,  Back  View  of   124 

Thigh,  Nerves  of   96 

Thorax,  Transverse  Section  of  116 

Thorax,  View  of    82 

Tibia,  or  Strong  Bone  of  the  Shin..   87 
Tongue,  The,  Showing  Mucous  Mem- 
brane and  Glands   99 

Transverse  Section  of  the  Thorax  or 

Chest     116 

Ulna,  or  Bone  of  the  Forearm 84 

Veins  of  the  Human  Leg 1 14 

Veins  of  the  Upper  Extremity  of  the 
Body    114 


Book  II. 


ANATOMY  AND    PHYSIOLOGY. 


Necessity  for  This  Book — A  brief  outline  of  tlie  structure  or  anatomy, 
and  of  the  function,  use  or  physiolony  of  tlie  human  organism  must 
necessarily  inaugurate  any  book  ijurporting  to  present  the  prevention  and 
cure  of  disease,  for  disease  means  disordered  function,  which  cannot  be 
understood  without  some  knowledge  of  the  normal  or  regular  function, 
which  in  turn  necessitates  a  study  of  structure. 

Plan  of  the  Book As  anatomy  and  physiology  are  naturally  insepar- 
able we  will  interweave  one  with  the  other  in  the  following  pages,  the 
part  played  by  an  organ  being  given  with  its  description. 

Bodily  Organs — Every  animal  is  composed  of  organs,  as  the  heart, 
liver,  kidney,  etc.,  and  every  organ  consists  of  tissues,  of  which  there  are 
four  varieties:  epithelial,  connective,  nervous  and  muscular.  Each  tissue 
is  made  of  numbers  of  cells. 

Forms  of  Cells — A  cell  is  a  microscopic  bag  of  jelly-like  substance 
called  protoplasm,  which  often  contains  within  its  substance  a  smaller  cell 
called  a  nucleus,  and  sometimes  inside  the  smaller  cell,  a  tiny  dot  called 
the  nucleolus. 

Protoplasm. — Protoplasm  is  formed  of  water,  albuminous  substances, 
sugary  material,  fat  and  chemical  salts.  The  chief  chemical  salts  enter- 
ing into  its  formation  are  carbon,  hydrogen,  oxygen  and  nitrogen. 

Size  of  Cells — Cells  vary    from    -^    to    ,-i-   of  an  inch  in  diaineter; 

*^  &U00  1-0  ' 

some  tubes  as  in  the  hair-like  blood-vessels,  and  some  float  in  fluid  as 
the  blood  corpuscles.  Some  have  the  power  of  moving  from  place  to 
place,  ameboid  motion. 

Human  Body  Compared  to  a  City. — The  human  body  may  be  compared 
in  its  arrangement  to  a  city,  the  houses  being  the  organs ;  the  brick,  stone, 
wood  and  metal  the  tissues,  and  tlie  individual  bricks,  fragments  of  stone, 
boards  or  pieces  of  metal  the  cells. 

Human  Body  Compared  to  an  Army. — Huxley  compares  it  to  an  army, 

(T3) 


u 


AITATOMY    AND    PHYSIOLOGY, 


Figure   S. — PAVE- 
MENT    EPITHELIUM. 


"each  cell  is  a  soldier,  an  organ  a  brigade,  the  central  nervous  system 
tLe  headquarters  and  field  telegrajih,  and  the  alimentary  and  eircidatory 
systems  the  commissariat."  The  function  of  a  cell  is  the  same  as  that  of 
a  human  being,  they  absorb  food  and  gi-ow,  fill  special  offices,  as  protect- 
ing, secreting,  etc.,  reproduce  and  die. 

Epithelium. — Epithelial  tissue  or  epithelium  means  literally  upon 
the  ni^jple.  It  covers  the  entire  outside  of  the  body,  as  the  skin,  the  in- 
side of  the  respiratory,  alimentary  and 
genito-urinary  apparatuses  as  mucous 
membrane,  and  dips  down  into  the  va- 
rious glands  which  open  on  the  skin  and 
mucous  membrane. 

Skin  Arrangement. — On  the  skin  it 
is  arranged   in  layers  as  pavement  epi- 
thelium  (Fig.  S)    and  acts  as  a  protec- 
tion to  the  delicate  structures  beneath.     In  some  places, 
as  in  the  hair  and  nails,  it  is  much  modified  to  more  effect- 
ually guard   against  injury. 

Shape  in  the  Stomach — In  the  stomach,  intestines  and 
elsewhere  the  eijithelial  cell  is  oblong  in  j^rofile  (Fig.  9) 
and  is  called  columnar  epithelium. 

Cilia   of   Windpipe. — Some 
epithelium,    like    that    in    tho 
windpipe,  has  projecting  from  It  long  waving 
filaments   called   cilia    (Fig.    10),      The   cilia 
wave  constantly,  acting  as  brooms,  which  keep 
the  windpipe 
clean. 
Glandular  Epithelium. — Secretory  or 
glandular  epithelium  (Figs.  11  and  12)  is 
found  in  the  glands,  varies  in  shape,  and 


Figure  9. — CO- 
LUMNAR EPI- 
THELIUM. 


rigure   10. — CILIATED   EPI- 
THELIUM. 


ricure    11. — SIMPLE    GLAND. 


RACEMOSE    QLANIX 


BONE   STEUCTUEE    ANT)    TISSUE. 


75 


is  the  essential  portion  of  tlie  gland,  i.  c,  tlie  portion  which  manufactures 
the  special  secretion  from  the  blood. 

Endothelium — Endothelium,  lining  serous  sacs,  joint  cavities  (syno- 
vial sacs),  and  the  blood  and  lymphatic  vessels,  is  analogous  to  epithelium. 

Connective  Tissue. — Connective  tissue  occurs  as  bono,  cartilage  and 
fibrous  connective  tissue. 

Bone  Structure. — Bone  is  fibrous  tissue  cemented  with  petrified 
cement.  It  consists  approximately  of  one-third  animal  and  two-thirds 
earthy  material,  the  jiriucipal  earthy  constituents  being  the  phosphate 
and  carbonate  of  lime;  lining  bone  is  pinliish  in  color  and  oozes  blood 
when  cut. 

Periosteum — Externally  it  is  covered  by  a  membrane  called  perios- 
teum. The  shafts  of  long  bones  are  hollow,  the  cavity  being  filled  by  the 
marrow,  which  consists  of  blood  and  lymph  vessels,  nerves  and  fat  sup- 
ported by  fibrous  tissue. 

Tissue  of  Bones — Bone  tissue  is  of  two  kinds,  spongy,  which  forms 
the  very  thin  bones  and  the  ends  of  long  bones,  and  compact,  which  is 
found  in  the  shafts  of  long 
bones  and  in  the  outside  of  flat 
bones.  Spongy  bone  is  made 
up  of  a  meshwork  of  bony 
arches,  the  spaces  filled  with 
vessels,  bone  cells  and  connec- 
tive tissue. 

Compact     Bone Compact 

bone  (Fig.  5)  consists  of  a 
series  of  concentric  layers  of 
bone  disjiosed  aroimd  a  canal 
called  the  Haversian  canal 
which  affords  the  passage  for  the 
blood-vessels.  The  layers  of 
bone  are  separated  from  each 
other  by  small  spaces  called 
lacunae,  and  passing  through 
the  bony  layers  and  connecting 
the  lacunae  are  many  fine  chan- 
nels called  canal  iculi ;  they 
serve  to  convey  nourishment  to 
the  bone  cells.  The  function 
of  bone  is  to  support,   to  protect,    and   to  give   attachment   to   musclee. 


Figure  B. — SECTION  OF  BONE,  MAGNrFIED. 


Y6 


AITATOMT    AND    PHTSIOLOGT. 


Structure  of  Gristle. — Cartilage  or  gristle  (Fig.  4)  is  fibrous  tissue 
gluod  together  by  a  substance  containing  chondrine.  It  has  no  blood- 
vessels but  is  nourished  by  lymph  which  filters  through  it  by  means  of 
small  spaces  and  canals  analogous  to  the  lacuna;  and  canal  iculi  of  bone. 

Use  of  Gristle. — Cartilage  forms  a  smooth  covering  for  the  ends  of 
bones  entering  into  a  joint ;  acts  as  a  buffer  between  the  bones  of  the  spine, 
prevents  certain  tubes,  like  the  windpipe,  from  collapsing,  and  as  in  the 
external  ear  gathers  sound. 


Figure  3. 


Figure  4. 


Figure    3.- 
Figure    4.- 


-FAT. 
-CARTILAGE. 


[  Magnified, 


ribrous  Tissue. — Fibrous  tissue  consists  ultimately  of  fibres  which  are 
developed  from  spindle-shaped  cells.     Its  function  is  to  hold  the  various 


Figure    67. — NERVE    CELLS. 


parts  of,  and  the  organs  themselves,  together.     Fatty  tissue   (Fig.  3)   is 
fibrous  connective  tissue  unfiltrated  with  fat. 

Nervous  Tissue. — Nervous  tissue  is  either  gray,  which  is  a  mass  of 
tailed  cells  (Fig.  57)  supported  by  a  fine  connective  tissue  (neuroglia),  or 


BONES    OF    THE    BODY. 


rr 


white,  whicli  is  made  of  bundles  of  little  nerve  febrils,  each  febril  is  the  tail 

of  a  cell  in  the  gray  nervous  tissue  and  is 
surrounded  in  some  places  by  the  white 
substance  of  Schwann  (Fig.  58)  and  by  a 
i)rimitive  sheath. 


Figure  6. — STRIPED  MUSCLE.  1,  longitu- 
dinal section:  2.  3.  4.  cross  section;  5,  de- 
taclied   disk:    7.    8,    Hbrijla;. 


del    0  H 


Figure  68. — NERVES.  a,  axis 
cylinder;  b.  Inner  border  of  wtiite 
substance;  c,  c.  outer  border  of 
same:  d,  d,  tubular  membrane;  B. 
tubular  iibres;  e.  in  natural  state; 
f,  under  pressure;  g.  varicose 
fibres. 


Muscular  Tissue. — 
kinds  of  miiscular  ti.ssut 
striped,  and  the  in- 
voluntary or  non- 
striated.  Volun- 
tary muscle  (Fig. 
6)  is  composed 
microscopically  of  the  primitive  fasciculi  (minute 
bundles  of  febrils),  each  febril  of  which  consists 
of  a  row  of  disks  (Fig.  6)  called  sarcous  elements. 
Involuntary  muscle  is  built  of  a  number  of  non- 
striped,  spindle-shaped  cells  (Fig.  7)  which 
branch  and  join  with  one  another. 


There 

tllO    V 


are 

I )]  nil  tar 


two 
V  ur 


THE  BONES. 


Figure     7. — NON-STRIATED 
MUSCLE. 


rramework  of  the  Body — The  body  skeleton  (Fig.  13)  forms  the 
framework  of  the  body.  Bones  are  divided  into  long,  short  and  flat  bones. 
The  long  bones  consist  of  a  hollow  shaft  of  compact  bone,  and  two  broader 
extremities  of  cancellated  bone.  They  are  found  in  the  extremities  and 
form,  levers  by  which  the  trunk  is  moved. 


la 


ANATOMY    AND    PnTSIOLOQT. 


Figure    13.— HUMAN    SKELETON. 


Short  Bones. — Short  bones  are  placed  where  strength  is  more  neces- 
sary than  mobility,  as  in  the  hand  and  foot;  their  structure  is  spongy, 
covered  by  a  thin  layer  of  compact  bone. 


THE  SPINE. 


78 


Flat  Bones. — The  flat  bones  are  foiind  where 
protection  of  important  organs  is  necessary,  as  in 
the  skull,  sternum  and  scapula?.  They  consist  of 
two  tables  of  compact  bone  filled  in  with  cancellous 
tissue.  Certain  bones  do  not  belong  to  one  class 
alone  and  are  called  mixed  bones. 

Number  of  Bones.— There  are  in  the  adult 
skeleton,  excluding  the  teeth,  ossicles  of  the  ear, 
and  Wormian  bones,  200  separate  bones.  These 
are: 

In  the    spinal   column :;6 

In  the  skull    8 

In  the  face   14 

Ribs,  breast  bone  and  Iiyoid  bone 26 

Upper  extremity    64 

Lower    extremity    > 62 

THE  SPINE. 


Spinal  Column. — The  spine  (Fig.  14)  is  a  flex- 
ible column  made  of  small  bones  called  vertebrae, 
seven  cervical,  twelve  dorsal,  five  lumbar,  five 
sacral  and  four  coccygeal  vertebra?. 

Spinal  Vertebrae. — A  vertebra  (Figs.  IG  and 
17)  consists  of  a  solid  portion  in  front  called  the 
body,  and  au  arch  behind,  so  that  when  placed 


la' 


Figure  16. 


Figure  17. 


Flprure  14. — SPINAL  COLUMN.  1,  atlas;  2,  axis;  3,  vertebra  prominens;  4,  twelve  dorsal; 
B,  fifth  lumbar;    G,  7,   sacrum;    8.   coccyx;   9,   a  spinous  process;   10,    10.   intervertebral   foramina. 

Figure  10. — DOKSAL  VERTEBRA.  1,  body;  2,  facet  for  rib;  3,  superior  surface  body; 
4,  5,  Intervetebral  notch;  6,  spinous  process;  7,  articular  facet  for  tubercle  of  a  rib;  8,  9, 
articular   processes. 

Figure  17. — LUMBAR  VERTEBRA.  1,  body;  2.  front  of  the  body;  3,  spinous  process; 
^  transverse  process;    5,   articular   process;    6,    arcb;    1,   splual   forameo. 


80  ATTATOMT    AND    PHYSIOLOGY. 

one  above  the  other,  as  in  Figure  14,  the  bodies  of  the  vertebrsB  form  a 
support  for  the  body  and  the  arches  a  canal  which  contains  and  protects 
tho  spinal  cord.  The  arches  are  formed  bv  a  plate  of  bone  on  each  side 
(lamina)  joined  to  the  body  or  constructed  portion  of  bone  (pedicle)  and 
imito  behind  to  form  the  spinous  process,  which  is  the  portion  one  feels 
when  running  a  finger  down  the  back. 

The  Atlas. — The  first  cervical  verte- 
bra or  atlas  (Fig.  15)  has  neither  body  nor 
spinous  process,  but  consists  of  an  anterior 
and  posterior  arch  and  two  lateral  masses 
on  which  rests  the  skull.  The  axis,  or 
cervical  vertebra  has  a  projection  from 
the  upper  surface  of  its  body  (odontoid 
Figure  15— ATLAS.    I,  anterior  tu-     proccss)  which  fits" in  the  anterior  arch  of 

bercle;    2,    facet    for   axis;    3.    posterior  .      .               i          i          i           •    i          i 

surface   spinal   canal;    4.    4,    Interverte-  the     atlaS,     permitting     the     head     With     the 

bral      notch;      transverse     process;      5,  ,                  .                          i    i»                  •  i                  •  i 

foramen    for    vertebral    artery;    7,    su-  atlaS    tO    be    rOtatcd    irOm    SldC    tO    Side, 

perior    articular    process;    8.    tubercle  frl,  „    c««««.«         n-il                                        •    i_         i: 

for   transverse   ligament.  The   Sacrum. 1  he  SECrum  COUSlstS  of 

five  vertebra?  welded  into  one  bone.  It  is 
triangular  in  shape  and  is  wedged  in  between  the  haunch  bones,  forming 
the  back  of  the  pelvis.  Attached  to  its  apex  is  the  coccyx,  which  consists 
of  four  vertebrae,  so  joined  as  to  form  one  bone. 

Ligaments — The  vertebrae  are  tied  together  by  ligaments.  Between 
each  vertebra  and  its  neighbor  is  a  disk  of  cartilage,  which  acts  as  a 
buffer  to  prevent  shock  and  allows  the  spine  to  bend  in  various  directions. 

THE  SKULL. 

Bones  of  the  Skull — The  skull  is  divided  into  the  cranium  or  brain 
case  and  the  face.  The  cranial  bones  are  one  occipital,  two  parietal,  one 
frontal,  two  temporal,  one  sphenoid  and  one  ethmoid.  The  occipital  bone 
forms  the  back  and  under  part  of  the  skull.  It  is  perforated  by  a  large 
opening  (foramen  magnum)  which  transmits  the  spinal  cord  to  the  spinal 
canal.  The  cerebellum  rests  on  its  inner  or  upper  surface,  the  external 
surface  gives  attachment  to  muscles. 

Side  and  Top  Bones The  parietal  bones  form  the  sides  and  top  of 

the  cranium,  joining  in  the  median  line  and  being  placed  between  the 
occipital  bone  behind  and  the  frontal  bone  in  front. 

Frontal  Bone. — The  frontal  bone  forms  the  forehead  and  forms  the 
roof  of  the  orbit,  on  the  upper  surface  of  which  rests  the  brain.     The 


BONES   OF    THE   FACE. 


81 


orbital  plates  are  separated  by  the  ethmoid  bone,  which  is  spongy  and  filled 
with  perforations  which  transmit  the  nerves  of  smell  to  the  nose. 

Temporal  Bone. — The  temporal  bone  consists  of  a  squamous  or  scale- 
like portion  which  overlaps  the  parietal  bone,  and  a  petrous  or  stony 
portion  which  helps  form  the  floor  of  the  cranium.  The  petrous  portion 
lodges  In  the  internal  and  middle  ear. 

Sphenoid  Bone. — The  sphenoid  resembles  a  butterfly  in  shape.     It  is 


Figure  IS. 


Figure  19. 


Figure  18.— FRONT  OF  THE  SKULiL.  1.  OS  frontalis;  2,  globella;  3,  supraorbital  ridge; 
4.  optic  foramen;  6.  sphenoidal  fissure;  6,  spheno-maxlllary  Assure;  7,  lachrymal  fossa;  8,  an- 
terior nares;  9.  intraorbital  foramen;  10.  malar  bone;  11.  symphysis  menti;  12.  anterior  mental 
foramen;  13,  ramus  of  the  lower  jaw;  14,  parietal  bone;  15.  coronal  suture;  16,  temporal 
bone;    17,   squamous   suture;    18,    great    wing   of   the    sphenoid. 

Figure  19. — BASE  OP  THE  SKULL.  1.  hard  palate;  2,  foramen  incisivum;  3.  palatine 
plate  of  palate  bone;  4,  crescenteric  ridge;  5,  vomer;  6,  internal  pterygoid  plate;  7,  pterygoid 
fossa;  8.  external  pterygoid  plate;  9.  temporal  fossa;  10,  basilar  process;  11.  foramen  mag- 
num; 12,  foramen  ovale;  13,  foramen  spinale;  14,  glenoid  fossa;  15,  meatus  aditorius  externus; 
16,  foramen  lacerum  anterius;  17,  carotid  foramen;  18,  foramen  lacerum  posterius;  19,  styloid 
process;  20,  stylo-mastoid  foramen;  21,  mastoid  process;  22,  condyles  of  occipital  bone;  23, 
posterior    condyloid    foramen. 

the  keystone  of  cranial  architecture  binding  the  bones  of  the  bead  firmly 
together. 

Facial  Bones. — The  facial  bones  are:  two  nasal  bones,  forming  the 
bridge  of  the  nose;  two  superior  maxillary  (upper  jaw)  ;  two  lachrymal, 
forming  a  portion  of  the  inner  wall  of  the  orbit ;  two  malar  br  cheek  bones ; 
two  palate  bones  forming  the  back  part  of  the  roof  of  the  mouth  and  the 
corresponding  portion  of  the  floor  of  the  nose;  two  inferior  turbinated 
bones  which  are  scrolls  of  bone  placed  in  either  nostril ;  one  vomer,  form- 
ing the  partition  between,  the  nostrils;  and  the  lower  jaw  or  inferior 
6 


82 


ANATOMY    AND    PIITSIOLOGT. 


maxillary  bono,  horseshoe  in  shape,  joining  with  the  temporal  bone  above 
and  being  freely  movable  below  to  permit  chewing,  talking,  etc 

Hyoid  Bone. — The  hyoid  bone  is  U-shaped,  situated  in  the  neck  just 
above  the  larynx  and  gives  attachment  to  many  muscles  of  the  tongue 
and  throat. 

THE  THORAX. 

The  Chest. — The  thorax  or  chest  is  an  elastic  bony  cage  made  by 
the  breast  bone  in  front,  the  spine  behind,  and  the  ribs  and  their  cartilages 
at  the  sides.  It  is  filled  by  the  heart  and  lungs,  which  it  protects.  The 
sternum  or  breast  bone  occupies  the  middle  line  anteriorly,  is  flat,  and  is 
made  of  three  pieces,  the  manubrium  (handle),  the  gladiolus  (blade),  and 
the  pointed  extremities,  the  ensiform  or  xiphoid  appendix,  these  names 
were  given  by  the  ancients  who  compared  it  to  a  sword. 

The  Ribs. — There  are  twenty-four  ribs  (Fig.  20),  twelve  on  each  side. 
They  are  joined  to  the  vertebra  behind  and  to  the  sternum,  by  means  of  car- 
tilages, in  front.  They  are  irregularly 
Bemicircular  in  shape,  flattened  antero- 
posteriorly,  and  slightly  twisted  on  them- 
selves. The  head  joins  the  vertebra  be- 
hind, the  neck  is  the  constriction  in  front 
of  the  head  and  the  angle,  the  point  of 
greatest  curvature.  The  seven  upper 
ribs  unite  directly  with  the  sternum  and 
are  called  true  ribs.  The  other  five  are 
called  false  ribs,  the  upper  three  being 
united  in  front  to  the  cartilages  of  the 
ribs  above  them,  and  the  last  two 
having  no  attachment  in  front  are  termed 
floating  ribs. 


aS7, 


THE  UPPER  EXTREMITY. 


Figure  20. — THORAX.  1,  manu- 
brium; 2,  gladiolus;  3,  ensiform  pro- 
cess; 4,  first  dorsal  vertebra;  5,  twelftli 
dorsal  vertebra;  6,  first  rib;  7,  its 
head;  8,  Its  necli;  9,  Its  tubercle;  10, 
last  true  rib;  11,  Its  cartilage;  12, 
angle  of  eleventh  rib;  13,  Its  body. 


The  Shoulders. — The  upper  extrem- 
ity cousists  of  the  shoulder,  the  arm, 
the  forearm,  and  the  hand.  The  bones  of 
the  shoulder  are  the  clavicle  and  scapula 
connecting  the  arm  Avith  the  trunk.     The 

clavicle,  collar,  or  key-bone  is  a  short  bone  curved  like  the  letter  f,  rimning 

horizontally  between  the  sternum  and  scapula. 


BONES  OE"  THE  FOEEAEM. 


85 


The  Scapula — The  scapula  (Fig.  21)  forms  the  back  of  the  shoulder, 
is  triangular  in  shape,  the  apex  pointing  downward  and  lies  on  the  ribs. 
On  the  upper  part  of  the  outer  surface  is  a  thick  triangular  spine,  the 
outer  extremity  of  which  (the  acromion)  forms  the  point  of  the  shoulder. 

Socket  of  the  Shoulder. — Beneath  this  process  the  upper  angle  is 
hollowed  out  to  relieve  the  upper  end  of  the  arm  bone.  In  front  of  this 
depression  is  a  curved  prominence,  the  coracoid  process. 

Arm  Bone. — The  humerus  (Fig.  22)  or  arm  bone  consists  of  a  long 
cylindrical  shaft,  having  a  rounded  head  above  for  articulation  with  the 


r/^'- 


Figure   22. 


Figure  21. — SCAPULA.  1,  1,  1,  oblique  ridges;  2,  3,  subscarular  fossa;  3,  superior  border; 
4,  superior  angle;  5.  supra-scapular  notcli:  C,  coracoid  process:  7,  acromion  process;  8,  spine 
of  scapula;  9,  articular  surface;  10,  glenoid  cavity;  11.  head  of  scapula;  12,  neck;  13,  in- 
ferior border;  14,  inferior  angle;   15,  posterior  border;   16,  origin  of  the  spine. 

Figure  22. — HUMERUS.  1,  shaft;  2,  head;  3.  anatomical  necit;  4,  greater  tuberosity;  B, 
lesser  tuberosity;  C,  bicipital  groove:  7,  ridge  pectoralis  major;  S,  internal  bicipital  ridge; 
9,   insertion   of  deltoid    muscle;    10,    nutrient    foramen;    11,    facet    for   radius;    12,    facet    for   ulna. 

scapula,  and  a  broad  flattened  lower  extremity  for  articulation  with  the 
forearm  bones. 

The  Forearm. — The  bones  of  the  forearm  are  the  ulna  and  the  radius. 
The  ulna  (Fig.  24)  lies  on  the  inner  side  of  the  forearm  when  the  palm  of 
the  hand  faces  upward.  The  upper  extremity  wliich  joins  the  humerus, 
has  two  processes,  the  olecranon,  forming  the  point  of  the  elbow  and  the 
coronoid  process,  which  complete  the  hinge  joint  of  the  elbow  in  front. 


84 


ANATOMY    AND    PnYSIOI.OGT. 


The  lower  end  of  the  uhia  is  small  and  does  not  articulate  with  any  bone 
of  the  wrist. 

The  Radius The  radius  (Fig.  23)  lies  on  the  outer  side  of  the  fore- 
arm. It  lias  a  cup-shaped  head  for  articulation  with  the  humerus.  The 
rounded  edge  of  the  bead  fits  in  a  concavity  of  tlie  ulna  and  is  surrounded 


Figure   23. 


Figure    24. 


Figure  25. 


Figure  23. — RADIUS.  1,  head;  2,  articulates  with  ulna;  3.  neck;  4,  tuberosity;  B,  In- 
terosseus  ridge;  6.  articulates  with  ulna;  7,  carpal  surface;  8,  styloid  process;  9,  insertion 
of    pronator    quadratus. 

Figure  24. — ULNA.  1,  olecranon:  2,  sigmoid  cavity;  3.  coronoid  process;  4,  lesser  sig- 
moid cavity;  5,  external  surface:  6,  interosseus  ridge;  7,  articulates  with  radius;  8,  carpal 
surface. 

Figure  25.. — CARPUS.  1,  ulna;  2,  radius;  S,  interartlcular  cartilage;  4,  metacarpal  of 
thumb:  5.  6,  7.  8,  metacarpal  bones  of  fingers;  S,  scaphoid;  L.  semilunar;  C,  cuneiform:  P, 
pisiform;    T,    T,    trapezium   and    trapezoid:    M.    magnum;    U,    unciform. 

by  a  sling-like  ligament,  which  allows  the  head  to  rotate.  The  lower 
extremity  is  larger  and  is  hollowed  out  to  fit  the  wrist  bones. 

The  "Wrist. — The  wrist  or  carpus  consists  of  eight  small  bones  in  two 
rows  (Fig.  25).  In  the  upper  row,  beginning  at  the  radial  side,  are  the 
scaphoid,  semilunar,  cuneiform,  and  pisiform  bones ;  in  the  lower  row, 
the  trapezium,  trapezoid,  or  magnum  and  unciform  bones. 

The  Hand — The  band  is  made  of  five  short  cylindrical  bones  called 
the  metacarpal  bones   (Fig.  25),  to  the  lower  extremity  of  which  are 


BONES  OF   TIIIOII   AND   LEG.  85 

attached  the  finger  bones  or  phalanges,  there  beiHg  two  for  the  thumL  and 
three  for  each  finger. 

THE  lOWER  EXTREMITY. 

Parts  of  lower  Extremity — The  lower  extremity  consists  of  throe 
parts,  the  thigh,  the  leg  and  the  foot,  and  is  united  to  the  trunk  by  the 
OS  innominatum  or  haunch  bone,  ■which  bears  the  same  relation  to  the 
lower  extremity  that  the  bones  of  the  shoulder  do  to  the  upper  extremity. 

The  OS  innominatum  (Fig.  26)  consists  of  the  ilium,  ischium  and 
pubes,  which  in  the  adult  grow  together  and  form  one  single  bore.  It  is 
irregularly  oblong  in  shape  and  twisted  upon  itself.  The  ilium  is  the 
broad  upper  part  of  the  bone  and  forms  the  prominence  of  the  hip.  The 
ischium  is  the  V-shaped  lower  portion  upon  wbieh  we  sit.  The  pubes  is 
situated  in  front  and  is  also  V-shaped;  in  the  adult  the  upjjer  part  is 
covered  by  hair.  Between  these  V-shaped  bones  is  a  large  opening,  the 
obturator  or  thyroid  foramen. 

Hip  Socket. — At  the  junction  of  the  three  bones  is  a  cup-shaped 
cavity,  the  acetabulum  or  socket  of  the  hip,  which  receives  the  rounded 
bead  of  the  thigh  bone.  In  front  the  pubic  bones  join  and  behind  the 
sacrum  complete  the  bony  ring  of  the  pelvis.  The  pelvis  (Fig.  26)  is 
basin-shai^ed,  supports  the  contents  of  the  abdomen  and  the  trunk  ujion  the 
limbs. 

Thigh  Bone. — The  femur  (Fig.  27)  or  thigh  bone  is  the  largest  and 
strongest  bone  in  the  body.  It  consists  of  a  shaft  and  two  extremities. 
The  upper  extremity  consists  of  a  head  which  is  spherical  and  smooth, 
fitting  into  the  acetabulum,  and  a  neck  which  joins  the  shaft  at  an  obtuse 
angle.  The  shaft  siipports  the  body,  is  an  important  lever  in  locomotion 
and  gives  attachment  to  muscles.  The  lower  extremity  resembles  the 
lower  end  of  the  humei'us ;  it  is  smooth  and  joins  with  the  main  bone  of 
the  leg,  the  tibia. 

Knee  Pan — The  patella  or  knee  pan  is  a  small  flat  bono  situated  in 
the  huge  tendon  of  the  great  muscles  on  the  front  of  the  thigh.  It  protects 
the  knee  joint  and  increases  the  leverage. 

Leg  Bones. — The  leg  bones  are  the  tibia  or  shin  bone  (Fig.  27a)  and 
the  fibula  (Fig.  28).  The  tibia,  the  larger  and  stronger,  is  expanded 
above  to  join  the  femur;  the  shaft  is  triangular,  the  sharp  edge  in  front 
may  be  readily  felt  beneath  the  skin  as  the  shin.     The  lower  exti'emity 


gg  ANATOMY    AND    PHYSIOLOGY. 

forms  the  inner  part  of  the  ankle  joint.     The  fikila  (Fig.  2S)  is  a  long, 
slender  bone  lying  on  the  outside  of  the  leg.     Its  upper  end  joins  the  ex- 


Figure    26. 

Figure     20. — MALE    PEI^VIS. 

panded  upper  extremity  of  the  tibia,  strengthening  it,  the  lower  end  forms 
the  outer  part  of  the  ankle  joint. 

Foot  Bones — The  foot  (Fig.  29)  consists  of  the  tarsus  or  ankle  bones, 
the  metatarsus  or  foot  bones  and  the  phalanges  or  toe  bones.  The  bones 
of  the  tarsus  are  the  calcaneum,  os  calcis,  or  heel  bone,  the  astragalus 
"which  joins  the  bones  of  the  leg,  the  cuboid,  the  scaphoid  and  the  three 
cuneiform  bones.  There  are  five  metatarsal  bones  corresponding  to  the 
nietacarpar  bones  of  the  hand.  The  phalanges  are  similar  to  those  of  the 
hand,  there  being  two  for  the  great  toe  and  three  for  each  of  the  other  toes. 

THE  JOINTS. 

Where  two  bones  meet  a  joint  or  articulation  exists.  The  bones  may 
be  so  soldered  together  (Fig.  30)  as  to  form  an  immovable  joint,  as  in  the 
bones  of  the  skull;  they  may  be  slightly  movable  as  the  pelvic  and  ver- 
tebral joints,  or  they  may  be  freely  movable  as  in  most  of  the  articulations 
of  the  limbs.  The  freely  movable  joints  (Fig.  31)  are  the  hinges,  as  the 
elbow;  the  ball  and  socket,  as  the  shoulder;  the  gliding,  as  the  stemo, 
clavicular  articulation  and  the  ring  and  pivot  (Fig.  32)  joint,  as  the  atlo- 
axoid  articulation.    The  structures  entering  into  joint  formation  are  bonea. 


THE    MTISCI.ES. 


87 


cartilages,  ligaments  and  syuovial  membraiio  which  secretes  the  lubricat- 
ing fluid  of  the  joint.     (Figs.  30,  31  and  32.) 


Figure   27a. 


Figure   29 


Figure  27. — FEMUR.  1,  depression  for  round  ligament;  2,  head;  3,  depression  for  rotary 
muscles;  4,  great  trochanter;  5.  lesser  trochanter;  G.  roughness  for  gluteus  niaximus;  7,  lines 
aspera;  8,  gastrocnemius  insertion;  9,  external  condyle;  10,  depression  for  anterior  crucial 
ligament;   11,   depression  for  posterior  crucial   ligament;   12,   origin  of  internal   lateral   ligament. 

Figure  27a. — TIBIA.  1,  spine;  2,  articulates  with  femur;  3,  facet  for  fibula;  4,  head; 
6,  tubercle;  G.  6.  shaft;  7,  internal  malleolus;  S,  attaches  internal  lateral  ligament  of  ankle; 
9,    tarsal    surface;    10.    facet    for    fibula. 

Figure  2S. — FIBULA.  1,  head;  2,  articular  facet;  3,  insertion  of  external  ligament ;  4, 
Bhaft;  5,  5.  external  face;  6,  interosseus  ridge;  7.  facet  for  tibia;  8,  external  malleolus;  9, 
tarsal    surface. 

Figure  29. — FOOT  BONES.  1.  astragalus;  2.  Its  anterior  face;  3,  os  calcls;  4,  scaphoid; 
6,  internal  cuneiform;  G.  middle  cuneiform;  7,  external  cuneifurm;  8.  cuboid;  9,  9,  metatarsal 
bones;    10,    first   phalanx  of   big   toe;    11,    second   phalanx;    12,    13,    14,    phalanges    of   other    toes. 

It  will  Le  iinneces.sary  to  describe  the  individual  joints,   reference 
having  already  been  made  to  them  in  the  section  on  bones. 


THE  MUSCLES. 


Function  of  Muscles. — Muscles  are  familiar  as  the  flesh  of  animals. 
They  are  attached  to  bones,  ligaments,  cartilages  and  the  slcin,  and  bv  their 
contractions  cause  all  the  movements  of  the  body.  Some  muscles  are 
arranged  in  sheets  (Fig.  33),  some  are  spindle-shaped,  some  are  disposed 


88 


ANATOMY    AKU    I'llYSIOLOGT, 


Figure  30. 


Figrure  31. 


Figure  30. — ACROMIO-CLAVICULAR  and  SHOULDER  JOINTS.  1.  upper  acromlo-clav- 
Icular  ligament ;  2,  coraco-clavlcular  ligament ;  3,  coraco-acromial  ligament ;  4,  eoracold  liga- 
ment;   5.   capsular   ligament   of  shoulder;    6,    coraco- humeral    ligannent;    7,    long    head    of   bicepa. 

Figure  31. — HIP  JOINT.  1.  posterior  sacro-illac  ligament;  2,  greater  sacro-sclatlc  liga- 
ment ;  3,  lesser  sacro-sciatlc  ligament ;  4.  great  sciatic  notch ;  5,  leaser  sclat  Ic  notch ;  6,  coty- 
loid ligament;  7,  Ugazuentum  teres;  S,  attachment  for  capsular  ligament;  y,  obturator  ligament. 


Figure    S2. 


Figure  32. — SECTION  OF  ANKLE  JOINT.  1,  tibia;  2,  astragalus;  3.  oa  calcls;  4. 
scaphoid;  ri,  internal  cuneiform;  6,  metatarsal  of  big  toe;  7,  8,  first  and  second  phalanges  of 
great  toe;  9.  articular  cavity  between  tibia  and  astragalus;  10.  synovial  capsule  between 
astragalus  and  os  calcls;  11,  calcaneo-astragaloid  ligament;  12,  synovial  capsule  between  as- 
tragalus and  scaphoid;  13,  calcaneo  scaphoid  ligament ;  14.  calcaneo-cubold  ligament;  15, 
synovial  capsule  between  scaphoid  and  internal  cuneiform;  16,  synovial  capsule  between 
internal  cuneiform  and  first  metatarsal;  17,  metatarao-phftlangeal  articulation  of  great  toe; 
18,    phalangeal    articulation    of    great    toe. 


in  rings  like  the  muscle  which  closes  the  monthj  and  in  some  the  fihres 
spread  out  like  a  fan. 

Muscle  Attachments. — They  are  attached  by  fibrous  cord,  the  tendons, 
or  by  broad  fibrous  bands,  the  aponeuroses.  The  end  of  the  muscle  which 
has  the  firmer  attachment  is  called  its  origin  (Fig.  34),  the  other  end  its 


THE  musci.es.  89 

insertion ;  this  is,  as  a  rule,  merely  relative,  as  in  most  cases  the  muscles 
act  from  either  extremity;  for  instance,  the  sterno-cleido  mastoid,  the 
muscle  which  forms  the  prominent  cord  at  either  side  of  the  neck,  has  its 


Figure    33. 

Flguro    33. — MUSCLES,    BACK    VIEW.      The    fascia    is    left    upon    the    left    limbs;    removed 
from   the   right. 

origin  from  the  top  of  the  breast  bone  and  the  end  of  the  collar  bone,  and 
its  insertion  into  the  bony  prominence  of  the  skull  behind  the  ear,  its 
action  is  to  bow  the  head  and  turn  the  face  to  the  opposite  side ;  but  if  the 


90 


ANATOMY    AND    PHYSIOLOOT. 


head  be  fixed  it  serves  to  raise  the  ribs  and  is  thus  an  accessory  muscle  of 
respiration. 

Face  Muscles — Of  the  numerons  small  muscles  of  the  face  (Fig.  35), 
it  is  not  necessary  to  si)eak  here ;  as  a  rule  they  arise  from  the  bones  of  the 


Figure    34. 


Figure    34. — MUSCLES,     FRONT    VIEW.       On    the    right    half,     superficial    muscles;     left 
half,   deep   muscles. 

face  and  are  inserted  into  the  skin,  by  their  mobility  giving  expression 
to  the  countenance. 

Muscles  of  Chewing — The  muscles  of  the  orbit  will  be  taken  up  in 


THE  MTTSCI.es. 


91 


connection  with  the  eye.  The  muscles  of  mastication  are  the  temporal, 
masseter,  the  two  pterygoids  and  the  buccinator.  The  temporal  arises 
from  the  side  of  the  head  above  the  ear  and  is  inserted  into  the  top  of  the 
lower  jaw.  The  masseter  runs  from  the  bony  process  external  to  the  orbit, 
to  the  angle  of  the  jaw  and  forms  the  hard  mass  felt  in  the  cheek  when  the 
jaw  is  tightly  closed. 


/z     /o 


Figure   36. 

Figure  SS.^MUSCLES  OP  FACE,  JAW  AND  NECK.  1.  longus  colli;  2,  trapezius;  3. 
flterno-hyoid;  4,  sterno-mastoid:  6,  crico-thyroid;  6,  trapezius;  7,  constrictor  of  piiarynx;  8, 
sterno-mastoid;  9.  digastric;  10.  attrahens  aurem;  11.  mylo-hyoid;  12,  masseter;  13,  depressor 
of  lower  Up;  15,  orbicularis  oris;  17,  levator  of  upper  Up;  19,  levator  of  angle  of  moutli;  21. 
orbicularis  palpebrarum. 

Muscles  of  the  Jaw — The  pterygoids  run  from  the  base  of  the  skull 
to  the  lower  jaw,  moving  it  laterally.  The  buccinator  is  a  broad,  flat  sheet 
in  the  cheek  compressing  the  cheeks  as  when  blowing  or  whistling,  etc. 

The  stemo-cleido  mastoid  has  already  been  mentioned  above.  The 
muscles  of  tlie  larnyx  will  be  spoken  of  in  connection  with  diseases  of  the 
throat. 

Muscles  of  the  Back. — ^The  most  important  muscles  of  the  back  are 
the  trapezius,  which  pulls  the  head  back  or  the  shoulder  upward  or  back- 


92 


ANATOMT    AND    PHYSIOLOGY. 


ward  and  which  runs  from  the  occipital  bone  and  the  spine  as  far  as  the 
middle  of  tlie  back,  to  the  shoulder  bones;  the  latissimus  dorsi,  which 
draws  the  arm  do^vn■^vard  and  backward,  and  which  arises  from  the 
lower  ribs,  the  lower  half  of  the  spine  and  the  haunch  bone  and  is  inserted 
into  the  arm  bone  near  its  head;  and  the  erector  spinse  which  arises  from 
•\:o  pelvis  and  lumbar  vertebrae  and  is  inserted  into  all  the  vertebrae  above; 
it  inaiulains  the  spine  erect. 

Muscles   of   Thorax — Concerning  the   thorax  we  may  mention  the 


Figure   36. 


Figure  36. — MUSCLES  OF  BACK.  I.  trrpezius;  2.  Its  origin:  3.  spine  of  scapula:  4.  latls- 
3imu.s  dorsi;  5.  deltoid;  6.  infra-spinatus:  7,  external  oblique;  8.  gluteus  medius:  9,  gluteus 
maximus;  10,  levator  scapulae;  11,  rhomboideus  minor;  12,  rhomboideus  major;  13,  splenius 
caiiitus;  14,  splenius  colli;  15,  origin  latissin^us  dorsI;  16,  serratus  inferior  posticus;  17,  supra- 
spinatus;  18.  infra-spinatus;  19,  teres  minor;  20,  teres  major;  21,  long  head  triceps;  22.  ser- 
ratus major  amicus;    23,    internal   oblique. 

intercostal  (between  the  ribs)  muscles,  external  and  internal,  the  external 
set  raising  the  I'ibs  and  the  internal  set  depressing  the  ribs  in  respiration. 
The  Diaphragm. — The  diaphragm  is  a  musculo-fibrous  partition  form- 
ing the  dome  of  the  abdomen  and  separating  it  from  the  thorax.     It  is 


musci.es  of  the  abdombw. 


93 


J3^f' 


S^:^'i^S 


attached  to  the  lower  ribs  and  spinal  column  and  Is  perforated  by  tlie 
aorta,  inferior  vena  cava  and  gullet.  It  is  a  muscle  of  respiration  and 
expulsion. 

The  Abdomen. — The  abdomen  is  completed  in  front  and  at  the  sides 
by  a  thick  wall  of  muscles  which  not  only  aid  in  protecting  the  underlying 
structures  but  assist  in  expelling  the  urine,  feces,  etc.,  from  the  body. 
This  wall  is  made  of  the  external  oblique  muscle  which  runs  from  the 
ribs  downward  and  inward  to  tlie  pelvic  bones  and  linea  alba — the  linea 
alba  or  white  line  occupies  the  midline  of  the  abdomen  and  is  formed  by 
the  union  of  the  various  muscular  structures  of  the  abdominal  wall;  the 
internal  obliqiie  muscle  arises 
from  the  ilium  and  lower  fibrous 
part  of  the  external  oblique  (Pou- 
part's  ligament),  runs  upward  and 
inward  to  be  inserted  into  the  linea 
alba  and  lower  ribs;  the  transver- 
salis  which  runs  transversely  be- 
tween the  brain,  spine,  ribs  and 
pelvis  to  the  linea  alba,  and  the 
rectus  abdominalis  which  is  situ- 
ated near  the  middle  line  of  the 
body  and  runs  from  the  ribs  to 
the  pelvis. 

Breast  Muscles. — The  pecto- 
ralis  major  and  minor  muscles 
form  the  fleshy  masses  of  the 
breast.  They  run  from  the  collar- 
bone, breast-bone  and  ribs  to  the 
caracoid  process  of  the  scapula 
and  the  humerus,  the  fibres  con- 
verging from  their  origins  to 
their  insertions.  They  draw  the 
shoulder  forward  and  the  arm 
across  the  chest. 

Deltoid  Muscle — ^The  deltoid 
(Fig.  37)    forms  the  prominence 

of  the  shoulder.  It  arises  fi'om  the  clavicle  and  scapula,  the  fibres  con- 
verging to  be  inserted  into  the  humerus  just  above  the  middle.  It  raises 
the  arm  from  the  side. 

The  Biceps. — The  biceps  forms  the  prominence  on  the  front  of  the 


Miti^  mi'^fi^-'--  ^'■■■ 
m  '•'  'ifi  P0  r- ■■'■•'■■;'..  - 


vt- 


'  )7  W/ 


Figure    37, 

Figure  37. — CHEST  MUSCLES.  1.  stcrno- 
h>  Old ;  2.  Bterno-mastoid ;  3,  sterno-thyroid ;  4, 
sterno- mastoid;  5,  trapezius;  6,  clavicle;  7. 
origin  pecloralis  major;  S.  deltoid;  9,  lower 
edge  pectoral  is  major;  10.  middle  pect  oralis 
major;  11,  fibres  external  oblique;  12,  biceps; 
13,  teres  major;  14,  serratua  major  anticus; 
15,  external  oblique  Interlocking  with  serratus 
niaj  or. 


9-i 


ANATOMY    AND    PnYSIOLOOT. 


arm  when  tlie  forearm  is  flexed.  It  arises  from  the  scapula  by  two  heads 
and  is  inserted  into  the  upjier  end  of  the  radius.  It  flexes  the  forearm 
and  assists  in  snpinating  or  turning  it  over. 

The  Triceps. — The  triceps  arises  from  the  shoulder  hlade  and  the 
back  of  the  humerus  by  three  heads,  and  is  inserted  into  the  upper  end 
of  the  ulna.    It  extends  the  forearm. 

Muscles  of  Forearm — The  muscles  of  the  forearm  are  very  numerous, 
and  give  the  forearm  and  hand  a  multitude  of  movements.  The  muscles 
M-liich  turn  the  palm  downward  arc  called  pronators,  the  most  important 
of  these  is  the  pronator  radii  teres  Avhich  runs  from  the  inner  part  of  the 
lower  end  of  the  humerus  to  the  radius.     The  most  imjrortant  supinator 


Figure  38. 


Figure   39. 


Figure  38. — MUSCLES  OP  BACK  FOREARM.  1,  bleeps;  2,  brachlalls  Internus;  3, 
biceps:  4,  supinator  longus;  5,  extensor  carpi  radialis  longior;  6,  extensor  carpi  radialis 
brevior;  7,  Insertion  of  these  muscles;  S,  extensor  communis  digitorum:  9,  extensor  communis 
dlgltorum;  10.  extensor  carpi  ulnaris;  11.  anconeus;  12.  flexor  carpi  ulnaris;  13,  extensor 
minor   polUcls;    14.    extensor  major  polllcis;    15,    posterior   annular   ligament. 

Figure  39. — MUSCLES  OF  FRONT  FOREARM.  1.  biceps;  2.  brachialis  internus;  3, 
triceps;  4.  pronator  radii  teres;  5.  flexor  carpi  radialis;  6,  palmaris  longus;  7.  flexor  sublimua 
digitorum;  8.  flexor  carpi  ulnaris;  9,  palmar  fascia;  10.  palmaris  brevls;  11.  abductor  polllcis; 
12,    flexor    brevls   pollicia;    13,    supinator    longus;    14,    extensor    ossia    metacarpl    pollicls. 


MUSCLES   OF   THE   LOWER  BODY.  95 

or  muscle  -whicli  turns  the  palm  upward  (Fig.  38),  is  the  supinator  longus 
which  runs  from  the  outer  part  of  the  lower  end  of  the  humerus  to  the 
lower  end  of  the  radius. 

Flexors. — The  radial  and  ulnar  flexors  (of  the  wrist)  come  from  the 
inner  part  of  the  arm  hone  and  are  inserted  into  the  hand  bones.  Beneath 
these  muscles  lies  the  flexor  sublimus  digitorum  which  divides  into  four 
tendons  or  leaders,  one  for  each  finger.  These  leaders  are  split  so  as  to 
give  passage  to  the  leaders  of  the  flexor  profundus  digitorum  which  are 
inserted  into  the  ends  of  the  fingers.  The  thumb  is  moved  by  special 
muscles. 

Eadial  Extensors. — The  muscles  on  the  back  of  the  forearm  are  the 
longer  and  shorter  radial  extensors  (of  the  wrist),  which  lie  behind  the 
long  supinator  and  whose  tendons  are  inserted  respectively  into  the 
metacarpal  bones  of  the  first  and  second  fingers.  The  ulnar  extensor  of 
the  wrist  lies  on  the  idnar  side  of  the  forearm,  and  is  inserted  into  the 
metacarpal  bone  of  the  little  finger.  Between  these  muscles,  in  the  middle 
of  the  forearm  (Fig.  39),  is  the  common  extensor  of  the  fingers  which  is 
inserted  by  four  tendons  into  the  backs  of  the  last  two  bones  of  the  fingers. 
The  index  and  little  fingers  have  special  extensors.  The  hand  is  supplied 
by  a  number  of  short  muscles,  which  give  it  marvelous  dexterity. 

MUSCLES  OF  THE  LOWER  EXTREMITY. 

The  muscles  of  the  lower  extremity  consist  of  those  of  the  hip,  thigh, 
leg  and  foot.  The  psoas  magnus  and  the  iliacus,  the  former  from  the 
lumbar  vertebra,  the  latter  from  the  inside  of  the  ilium,  are  inserted 
together  into  the  upper  part  of  the  femur.  They  flex  the  thigh  and  roll 
it  outward.  The  buttocks  are  composed  of  the  three  glutei  muscles. 
They  arise  from  the  pelvic  bones  and  are  inserted  into  the  upper  part  of  the 
femur.  They  extend  the  hips,  raise  the  body  from  the  stooping  posture, 
and  hold  the  trunk  on  the  thigh  bones.  Partly  beneath  them  lies  a  group 
of  muscles  (Fig.  41),  the  rotators  of  the  hip;  they  are  the  pyriformis, 
gemelli,  the  internal  and  external  obturators,  and  the  quadratus  femoris. 

Thigh  Muscles. — The  rectus  femoris  with  the  vastus  externus  and 
internus  form  tlie  mass  of  muscle  on  the  front  of  the  thigh.  The  rectus 
arises  from  the  ilium,  the  vastus'  from  the  femur ;  they  join  to  form  a  com- 
mon tendon  which  is  attached  to  the  upper  end  of  the  tibia.  They  extend 
the  leg,  flex  the  thigh,  and  raise  the  body  from  the  sitting  to  the  stand- 
ing posture.  ^ 

The  Tailor's  Muscle — The  sartorius,  the  longest  muscle  in  the  body, 
nms  from  the  ilium  downward  and  inwird  across  tie  thigh  to  the  inner 


96 


ANATOMY    AND    PHYSIOLOGY. 


side  of  tbe  sLiii  bone  below  tbo  knee.     It  flexes  the  tbigli  and  crosses 


the  legs. 


The  biceps  femoris  arises  from  the  ischium  and  is  inserted  into  the 

^  head  of  the  fibula  (Fig.  40).     The  semimembranosus  and  the  semiteudi- 

nosus  take  origin  from  the  ischium  and  are  inserted  into  the  inner  part  of 


Figure  40. — NERVES  OF  THIGH.  1,  sympathetic  ganglia;  2.  third  lumbar;  3.  branches 
to  illacus;  4,  fourth  lumbar;  6,  anterior  crural;  6,  lurabo-sacral;  7.  branch  to  the  psoas;  8, 
obturator;  9.  external  cutaneous;  10.  nerve  to  pectineus;  11.  branch  anterior  crural;  12, 
superficial  division  of  obturator;  13.  sartorius  muscles;  14.  adductor  longus;  15.  branch  to 
rectus;  16.  deep  division  of  obturator;  17.  branches  to  vastus  externus  and  crureus;  18.  ad- 
ductor brevls;  19.  branch  to  vastus  Internus;  20,  adductor  magnus;  21.  vastus  externus;  22, 
Internal  saphena;  23,  rectus  femoris;  24,  patellar  branch  of  saphena;  25,  vastus  Internum; 
26.   gracilla. 

the  head  of  the  tibia.     They  extend  the  hips,  flex  the  knee,  and  raise  the 
body  from  the  stooping  position. 


MUSCLES    OF    THE    CALF. 


07 


Muscles  of  the  Calf. — The  calf  of  the  leg  is  made  of  the  solciis  arising 
from  tlie  upper  back  part  of  the  bones  of  the  leg,  and  the  gastrocnemius, 
arising  from  the  lower  end  of  the  femur ;  they  unite  in  a  common  tendon 
of  great  size,  tendo-achillis,  which  is  attached  to  the  back  of  the  hsel  bone. 
They  extend  the  foot  and  raise  the  weight  of  the  body  in  walking  and 
running.  Beneath  tliem  lie  the  popliteus  and  the  flexors  of  the  toes  cor- 
responding to  the  flexors  of  the  fingers  in  the  forearm.      The  extensor 


FigTiro    4 


Figure  41. — MUSCLES  BACK  OF  THIGH.  1,  fifth  lumbar  vertebra;  2,  ilio-lumbar  liga- 
ments;  3,  crest  of  ilium;  4,  anterior  superior  spinous  process;  5,  origin  of  fascia  femoris;  6, 
gluteus  medino:  7,  its  lower  and  anterior  portion;  8,  pyriformis;  9,  gemini;  10,  trochanter 
major;  11,  insertion  gluteus  medius:  12.  quadratus  femoris;  13,  adductor  magnus;  14.  inser- 
tion gluteus  maximus;  15,  vastus  extensus;  It:,  long  head  biceps;  17,  semimembranous; 
18,  semitendinosus;  19,  tuber  jschii;  20,  obturator  internus;  21,  point  of  coccyx;  22,  posterior 
coccygeal  ligament;  23,  24,  great  sacro-sciatic  ligament;  25,  posterior  superior  spinous  pro- 
cess;   26,   posterior  sacro-iliac   ligaments. 

Figure  42. — MUSCLES  FRONT  OF  LEG.  1,  tendon  of  quadriceps;  2,  spine  tibia;  3, 
tibialis  anticus;  4,  extensor  communis  digitorum;  5,  extensor  proprius  poIHcis;  6,  peroneus 
tertius;  7,  peroneus  longus;  8,  peroneus  brevis;  9,  soleus;  10,  gastrccnemius;  11,  extensor 
brevia    digitorum. 

longus  digitorum  is  attached  to  the  leg  bones  and  to  the  second  and  third 
phalanges  (Fig.  -12)  of  the  four  lesser  toes  by  four  tendons.     The  great 


98 


ANATOMY     AST)    rilTSIOI.OGY. 


too  lias  t\ro  special  flexors  .iiid  a  special  extensor  and  tlio  little  toe  a  special 
flexor. 

On  the  back  of  the  foot  is  one  miiscle  only,  the  extensor  brevis  digi- 
torum,  wliich  assists  the  long  extensor  of  the  toes. 

Sole  of  the  Foot — The  sole  of  the  foot,  like  the  palm  of  the  hand,  is 
covered  by  a  dense  fibrous  sheath,  the  plantar  fascia,  running  from  the 
heel  bone  to  the  metatarsal  bones  in  front;  it  sustains  the  arch  of  the 
foot,  and  protects  the  vessels  and  nerves  beneath.  Immediately  beneath 
it  lies  the  flexor  brevis  digitorum,  arising  from  the  heel  bone  and  being 
inserted  into  the  sides  of  the  second  bones  of  the  lesser  toes  by  four  ten- 
dons which  are  perforated  by  the  long  flexor  tendons;  and  just  below 
this  is  the  flexor  accessorius,  which  is  attached  to  and  aids  the  tendon  of 
the  long  flexor.  There  arc  numerous  other  small  muscles  in  the  foot 
which  give  it  complicated  movements. 

THE  DIGESTIVE  APPAHATTTS. 

What  it  Consists  of. — The  digestive  apparatus  consists  of  the  ali- 
mentary or  food  canal  (Fig.  72)  which  extends  from  the  mouth  to  the 
anus  and  is  between  twenty  and  thirty  feet  in  length,  and  of  the  various 
glands  which  open  into  it.  The  alimentary  canal  is  divided  into  the 
mouth,  pharynx,  OGS023hagus,  stomach,  small  intestine  and  large  intestine. 
Its  function  is  to  digest  or  convert  the  food  into  an  assimilable  form. 

The  Mouth — The  mouth  is  an  oval  cavity  containing  the  tongue  and 
teeth.    In  it  the  food  is  ground  up  and  mixed  with  saliva  (Fig.  68),  which 


yisure    «8. — SALrV'ART    GLANDS. 
duct;  5.  BubllDgual. 


Figure 

1,   carotid;    S,    Steno's    duct;    3,    submailUaqr; 


4,    Itl 


ttHE   STOMACff. 


99 


not  only  moistcTig  it  so  tliat  it  may  be  readily  s-n'anoT7C(l  bnt  acts  on  the 
Btarchy  foods,  changing  them  to  sugar.  The  teeth  are  described  iu  the 
chapter  on  teeth.  The  saliva  is  secreted  by  the  parotid  glad  below  and  in 
front  of  the  ear,  and  by  the  submaxillary  and  sublingual  glands,  which  lie 
in  the  floor  of  the  mouth. 

The  Tongue. — The  tongue  (Fig.  G9)  is  a  muscle  covered  by  mucous 
membrane,  containing  many  mucous  glands  and  little  projections  called 
papillffi  in  which  are  lodged  the  ends  of 
the  taste  nerves.  The  tongue  is  the 
organ  of  taste,  assists  in  articulation, 
and  aids  in  mixing  the  saliva  -with  food 
and  keeping  the  food  between  the 
teeth. 

The  Pharynx. — The  pharynx  is 
really  the  upper  part  of  the  cesophagus, 
expanded  into  a  muscular  bag.  It 
hangs  from  the  skull  above,  is  four  and 
a  half  inches  long,  and  communicates 
with  the  nose,  ear,  mouth,  cesophagus 
and  larynx. 

The  Gullet — The  cesophagus  or 
gullet  is  nine  inches  long,  of  same  con- 
struction as  the  pharynx,  and  empties 
into  the  stomach.  After  the  food  is 
chewed  it  is  forced  into  the  pharynx 
which  contracts  and  pushes  it  down 
into  the  oesophagus,  which  propels  it 
onward  to  the  stomach.  During  swal- 
lowing the  opening  into  the  larynx  is 
closed  by  a  little  trap  door  called  the 
epiglottis. 

The  Stomach — The  stomacH  (Fig.  70)  is  roughly  pear-shaped;  the 
big  end,  lying  on  the  left  side,  measures  twelve  inches'  transversely  and 
four  inches  vertically,  is  situated  just  below  the  diaphragm,  receives  the 
oesophagus  In  its  upper  left  wall  (cardiac  opening),  and  empties  into  the 
email  intestine  at  the  extreme  right  (pylorus) ,  the  opening  being  guarded 
by.  a  circular  valve  reinforced  by  muscular  fibres. 

The  Stomach  "Walls — The  stomach  wall  is  made  bf  four  layers:  ex- 
ternally the  peritoneimi  prevents  friction;  next  is  the  muscular  coat  which 
churns  the  food,  then  the  cellular  coat  which  carries   the  blood-vessels, 


Figur.:    63. 
THE   TONGUE. 


100 


ANATOMY    AND    TUYSIOLOOY. 


and  internally  is  tlic  mucous  membrane  (tripe  of  cow)  containing  thou- 
sands of  little  glands  (Pig.  71),  the  peptic  or  gastric  glands,  which 
secrete  the  gastric  jiiicc.  "When  food  reaches  the  stomach,  the  cardiac  ori- 
fice and  pylorus  close,  the  stomach  contracts  and  mixes  it  with  the  gastric 
juice,  which  is  now  freely  secreted. 

The  Gastric  Juice — Gastric  juice  is  made  of  water,  salts,  hydrochloric 
acid  and  pepsin.     It  changes  albumen  to  peptone,  which  is  readily  ob- 


Flgure    70. 


I-'iyure    71. 


Figure    70. — STOMACH. 

Figure    71. — STOIIACH    TUBULE. 


fundus;    c,    orifice;    m,    muscular    coat. 


sorbed,  dissolves  the  cellulose  of  vegetable  and  the  fibrous  tissue  of  meats. 
Water  and  some  of  the  peptones  are  absorbed  by  the  stomach.  The  re- 
maining piirtion  of  the  food,  now  a  liquid,  passes  on  into  the  intestines. 

Small  Intestine. — The  small  intestine  is  about  twenty  feet  in  length, 
one  inch  iu  diameter,  and  extends  from  the  stomach  to  the  cecum,  into 
which  it  empties.  It  is  connected  to  the  spine  by  a  fold  of  peritoneum,  the 
mensentery,  and  is  contained  in  the  lower  and  central  portion  of  the 
abdomen.  It  is  divided,  beginning  above,  into  the  duodenum,  jejunum 
and  ileum. 

Duodenum — Into  the  duodenum  empty  the  ducts  of  the  liver  and 
panci'cas.  The  small  intestine  has  four  coats  similar  to  those  of  the 
stomach.  In  the  small  intestine  the  albumens  are  changed  to  peptones, 
fat  emulsified,  and  starches  converted  into  sugars  by  the  action  of  the  bile 
from  the  liver,  the  pancreatic  juice  and  the  intestinal  juices.  The  pep- 
tones, fat  and  sugar  are  absorbed  by  the  intestinal  walls  and  the  remain- 
ing portion  of  the  food  passes  into  the  large  intestine,  which  also  absorbs 
to  a  slight  extent  the  nutritions  portions  of  its  contents,  which  are  now 
sensusated  and  are  called  feces. 


THE    LARGE    INTESTINE. 


101 


Large  Intestine. — The  large  intestine  is  five  feet  in  length,  runs  from 
an  enlarged  pouch,  the  cecum,  into  which  the  small  intestine  empties,  to 
the  anus.  It  is  about  three  times  as  large  in  calibre  as  the  small  intestine. 
The  cecum  is  situated  in  the  right  lower  corner  of  the  abdomen,  ending 


Figure  72. — ALIMENTARY  CANAL.  1,  3.  lips;  2.  4,  frccnum;  5.  cheek;  6.  Steno's  duct; 
7,  roof  of  mouth;  8,  half  arches;  9,  tonsils;  10,  velum;  ]1,  tongue:  12,  papiliee;  13,  trachea; 
14,  fesophagus;  15,  its  interior;  16,  stomach;  17,  its  greater  end;  18,  its  lesser  end;  19, 
lesser  curvature;  20,  greater  curvature;  21,  cardiac  orifice;  22,  pylorus;  23,  24,  25,  duodenum: 
2C,  valvulae  conniventes;  27,  gall  bladder;  28,  cystic  duct;  29,  30,  hepatic  duct;  21,  comnton 
bile  duct;  32,  its  opening;  33,  35,  jejunum;  34,  opening  of  pancreatic  duct;  3G,  38,  ileum; 
37,  V.  conniventes;  39,  i!eo-cecal  valve;  40,  41,  cecum;  42,  appendix  vermiformis;  43-48,  colon; 
49,   50,  rectum;"  51,   levator  ani;    52,    anus. 


below  in  the  vermiform  ajtpendix,  which  varies  from  throe  to  six  inches 
in  length  and  is  about  one-quartiu-  inch  in  diameter.  In  the  cecum  the 
large  intestine  ascends  to  the  liver  (ascending  colon),  passes  over  to  the 


102 


ANATOMY    AND    PHTSIOI.OQT. 


spleen  on  the  left  side  (transverse  colon),  descends  on  the  left  side  (de- 
scending colon)  to  the  pelvis,  wiiere  it  curls  like  an  S  (sigmoid  flexure) 
and  then  ends  in  the  rectum  -which  reaches  the  surface  of  the  body  as  the 
anus.  As  the  feces  accumulate  in  the  large  intestine  they  are  forced 
downward  to  the  sigmoid  flexure  and  rectum,  where  they  remain  until  ex- 
pelled from  the  body. 

The  Sweetbread — The  pancreas  (sweetbread)  is  a  long,  narrow  gland 
about  seven  inches  in  length  lying  behind  the  stomach.  Its  duct  opens 
in  common  with  the  bile  duct,  into  tlu;  duodenum. 

The  Liver — The  liver  (Fig.  74),  the  largest  gland  in  the  body,  weighs 
about  four  pounds,  and  is  situated  in  the  ' 
upper  right  comer  of  the  abdomen, 
where  it  is  retained  by  the  peritoneum 
which,  after  forming  its  outer  coat,  runs 
to  the  abdominal  walls  as  ligaments.  It 
is  divided  into  five  lobes,  which  are 
made  up  of  lobules,  each  about  one- 
twentieth  of  an  inch  in  diameter,  be- 
tween which  the  vessels  and  ducts 
ramify.    The  bile  duct  has  appended  to 


Figure    75. 


Figure    74. — LIVER.      R,    right    lobe;    L,    left    lobe;    Q,    quadrate    lobe;    S,    lobuB    Splgelll; 

C,  lobus  candatus;  1.  umbilical  vein;  2,  gall  bladder;  3,  hepatic  artery;  4.  hepatic  duct:  B, 
portal  vein;   6,  reflexion  of  peritoneum;   7,   vena  cava;   8,   ductus  venosus;   9,   common  bile   duct. 

Figure    75. — PERITONEUM.      I),    diaphragm;    L,    liver;    S,    stomach;    C,    transverse   colon; 

D,  transverse  duodenum;    P,   pancreas;   I,   small  intestine;   R,   rectum;   B,    bladder. 

it  a  pear-shaped  bag,  the  gall  bladder,  which,  lying  on  the  under  surface 
of  the  liver,  acts  as  a  reservoir  for  the  bile  during  the  intervals  of  diges- 
tion.   The  bile  duct  unites  with  the  pancreatic  duct  and  empties  into  the 


THE  LIVEK  AND  PEItlTONEUM. 


103 


duodenum.  The  liver  secretes  bile,  stores  up  sugar  from  the  blood,  helps 
make  blood,  destroys  poison  in  the  blood  and  excretes  urea  and  allied 
products. 

Peritoneum. — The   peritoneum    (Fig.    75)    covers   all   the   abdominal 
organs ;  it  is  a  serous  sac  containing  a  small  quantity  of  fluid  which  pre- 


Flgure   73. 
Figure   73. — LYMPHATICS,      a,   receptaculum   chyll;    e,    thoracic    duct;    v.    Innomonate   vein. 

vents  friction  between  the  organs  it  covers.  The  omentum  is  a  double  fold 
of  peritoneum,  which  falls  from  the  front  of  the  stomach  nearly  to  the 
bladder,  then  ascends  to  the  transverse  colon. 


104 


ANATOMY    AND    I' II  YSIOl.OOY. 


Absorption. — Absorption  nu-aiis  tlic  passage  of  materials  from  mucous 
surfaces,  serous  cavities  or  tissues  into  tlie  lyinph  or  blood-vessels. 

The  Lacteals. — Tlie  digested  fat  in  the  intestines  is  absorbed  by 
lympli  vessels,  called  lacteals,  because  their  contents  resemble  milk.  These 
lacteals  converge  from  various  parts  of  the  intestine  to  form  the  thoracic 
duct  which  passes  up  and  empties  into  a  large  vein  in  the  neck.  The  di- 
lated lower  end  of  the  thoracic  duct  is  called  the  receptaculum  chyli. 
The  lymph  from  the  tissue  all  over  the  body  is  collected  into  the  lymphatic 


Figure  56. 


Figure  B6. — LYMPHATICS.  1,  saphenous  vein-,  2,  external  Iliac;  3.'  common  lilac;  4, 
aorta;  5,  ascending  vena  cava;  6,  7,  lympliatics;  8,  lower  set  of  Inguinal  glands;  9.  su- 
perior set  of  inguinal  glands;  10,  chain  of  lymphatics;  11,  lymphatics  with  circumflex  iliac 
vessels;    12,    lumbar    and    aortic    lymphatics;    13,    origin    thoracic    duct;    14,    thoracic    duct. 

vessels  (Fig.  56)  which,  finally  by  two  big  trunks,  the  thoracic  duct  and 
the  right  thoracic  duct,  into  the  veins  of  the  neck.  On  its  way  to  the  blood 
the  lymjili  passes  through  the  lymph  glands  which  frequently  swell  when 
any  poison  passes  through  tlieni,  the  kernels  felt  in  the  neck  during  an 
attach  of  tonsilitis,  for  example. 


BLOOD— CIKCULATORY  SYSTEM. 

Composition  of  Blood. — Tlie  blood  is  made  from  the  food  we  eat,  and 
it  in  turn  feeds  all  the  tissues  of  the  body  and  drains  away  all  their  waste 


THE    HEART. 


105 


products.  It  consists  of  liquor  sanguinis  (liquid  of  blood)  and  corpuscles 
(little  bodies),  tbe  former  containing  water,  proteids,  salts,  nutritive  and 
cxcrementitious  matter.  The  corpuscles  (Fig.  54)  are  red,  which  are 
■j^^  of  an  inch  in  diameter,  circular  and  biconcave,  or  white,  which 
exist  in  the  proportion  of  one  to  three  of  four  hundred  reds,  are  ^jVir 
inch  in  diameter  and  possess  amoeboid 
motion.  When  blood  is  exf)osed  to  air  it 
clots,  a  stringy  material  proteid  in  nature,  ^  / 

fibrin,  which  exists  in  solution  in  the  liquor  ^ 

sanguinis,    entangles   the   corpuscles,   form- 
ing a  semisolid  mass.  ®         ® 

Function  of  Corpuscles Blood  corpus-         rignrow.-BLOoD  corpuscles. 

cleS  carry   oxygon   from   the   lungs   to   the 

tissues  and  the  liquor  sanguinis  carries  food ;  the  blood  drains  carbon 
dioxide  and  other  waste  pi-oducts  from  the  tissues  to  the  excretory  organs: 
skin,  kidney,  liver  and  limgs. 

Circulatory  Apparatus. — The  blood  is  carried  to  and  from  the  tissues 
by  the  circulatory  apparatus,  which  consists  of  the  heart,  arteries,  capil- 
laries and  veins.  The  heart  pumps  the  blood  through  the  arteries  to  the 
thin-walled  capillaries  where  the  food  passes  out  to  the  tissues  and  waste 
is  given  to  the  blood ;  from  the  capillaries  the  blood  drains  into  the  veins 
which  run  to  the  heart.  The  heart  then  sends  the  blood  to  the  lungs  to 
be  purified,  to  the  intestines  for  food  and  again,  pumps  it  out  to  the  tissues. 

The  Heart — The  heart  is  a  hollow  muscular  organ  of  conical  form, 
placed  in  the  chest  between  the  lungs  and  inclosed  in  a  serous  sac,  the 
pericardium.  It  is  placed  obliquely;  the  base,  to  which  is  attached  the 
great  vessels,  is  directed  upward  and  backward;  the  apex  is  directed 
downward  and  to  the  left,  and  corresponds  to  the  interval  between  the 
fifth  and  sixth  ribs,  one  inch  to  the  inner  side  and  two  inches  below  the 
nipple. 

In  a  grown  person  (Fig.  61)  the  heart  is  about  five  inches  in  length, 
three  and  a  half  inches  in  breadth  at  its  broadest  part  and  two  and  a  half 
inches  thick.  In  the  male  it  weighs  from  ten  to  twelve  ounces  and  in  the 
female  about  two  ounces  less. 

Heart  Divisions. — The  heart  is  divided  longitudinally  by  a  muscular 
partition  into  two  halves  and  a  transverse  partition  divides  these  halves 
into  two  cavities.  The  lower  cavities  are  called  ventricles  and  the  upper 
ones  auricles.  The  walls  of  the  auricles  are  thinner  than  those  of  the 
ventricles  and  the  walls  of  the  right  side  of  the  heart  are  thinner  than 
those  of  the  left. 


•106 


anato:my  axi>  niYsior.onY. 


Eight  Auricle — The  riglit  auricle  receives  tlie  blood  from  the  two 
main  veins  of  the  body — the  two  vena  cava.  Prom  the  auricle  the  blood 
is  forced  into  the  right  ventricle  through  the  auriculo-ventricular  orifice. 
This  opening  is  guarded  bv  the  tricuspid  valve,  to  prevent  the  reilux  of 
blood  into  the  auricle  when  the  ventricle  contracts.     This  valve  is  corn- 


Figure  51. 

Figure  51. — HEART  AND  LUXGS.  1.  left  auricle;  2,  right  auricle;  3.  left  ventricle;  4. 
right  ventricle;  5,  pulmonary  artery;  6,  arch  of  aorta;  7.  superior  vena  cava;  8,  Innominate 
artery;  9.  common  carotid;  10,  subclavian;  11.  trachea;  12,  larynx;  13,  upper  lobe  right 
lung;    14,    upper    lobe    left    lung;    15,    right    pulmonary    artery;    16,    lower    lobes    of    lungs. 

posed  of  three  segments,  to  the  free  margin  of  which  are  attached  ten- 
dinous cords,  which,  springing  from  the  muscular  ridges  projecting  from 
the  inner  surface  of  the  ventricle,  the  columnte  carnese,  give  support  to 
the  valves. 

Hight  Ventricle. — The  walls  of  the  right  ventricle  (Fig.  52)  are 
about  one-third  as  thick  as  those  of  the  left  ventricle.  Beside  the  opening 
into  the  auricle  there  is  the  opening  into  the  pulmonary  artery  which  is 
guarded  by  the  semihmar  valves,  three  semicircular  folds  of  the  lining 
membrane  of  the  heart. 

Course  of  the  Blood. — The  blood  is  forced  from  the  right  ventricle 
through  the  pulmonary  artery  to  tlie  lungs,  tlie  .semilunar  valves  closing 
after  each  contraction  of  the  ventricle  so  preventing  any  backward  flow. 


THE    HEART. 


107 


Xeft  Auricle — The  left  auricle  is  smaller  than  the  right  but  thicker; 
it  receives  the  blood  wliich  returns  from  the  lungs  by  the  pulmonary 
veins  and  forces  it  into  the  left  ventricle  through  an  opening,  guarded  by 


P'igure    5  2. 

Figure  S2. — HEART.  1,  superior  vena  cava:  2.  inferior  vena  cava;  2',  hepatic  veins;  3, 
right  auricle;  3'.  fossa  ovalis;  3",  aperture  coronary  vein;  _|_,  _|_,  in  auricula-venlricuiar 
groove;  4.  4,  cavity  right  ventricle;  4'.  columna;  carnse;  5',  5",  tricuspid  valve;  G,  pulmonary 
ertery;  7,  concavity  aortic  arch;  8,  ascending  aorta;  9,  between  innominate  and  left  carotid; 
10,   auricular   appendage;    11,   11,    left   ventricle. 

valves,  similar  to  the  right  auriculo-ventricular  orifice,  except  that  the 
valve,  called  the  mitral  valve,  has  but  two  segments. 

Left  Ventricle — The  left  ventricle  is  the  thickest  and  strongest  por- 
tion of  the  heart.  The  blood  received  by  it  through  the  auriculo-ven- 
tricular orifice  is  discharged  into  the  main  artery  of  the  body,  the  aorta, 
througli  an  opening  which  is  guarded  by  semilunar  valves  (Fig.  53)  as 
in  the  case  of  the  pulmonary  artery.  The  cavities  of  the  heart  are  lined 
by  a  delicate  endothelium,  which  is  continuous  with  that  of  the  blood- 
vessels. 


108  ANATOMY    AND    niTSIOLOOT. 

Pulsation — The  heart  pulsates  from  seventj-five  to  eighty  times  per 
miinitn  iu  the  adult;  in  childhood  it  is  more  rapid.  The  strenjjth  and 
rapidity  arc  governed  bj  the  nerves  v\-hich  supjtly  the  heart  with  force. 

Heart  Sound. — Upon  listening  to  the  heart  two  sounds  are  heard. 
The  first  sound,  dull  and  heavy, 
is  caused  by  the  contraction  of 
the  heart,  the  shutting  of  the 
auriculo-ventricular  valves  and 
the  rush  of  blood.  The  second 
sound,  sharp  in  character,  is 
due  to  the  snapping  shut  of  the 
semilunar  valves.  ^'^""'  ".-sKii.i.uxAK  valves. 

ARTERIES. 

rnnction  of  Arteries. — The  arteries  carry  the  blood  from  the  heart  to 
all  parts  of  the  body.  It  has  three  coats,  an  outer  areolar  elastic  coat, 
a  middle  muscular  coat  and  an  inner  endothelial  coat. 

The  Aorta — The  main  artery  of  the  body  is  called  the  aorta  (Fig. 
43).  It  springs  from  the  left  ventricle,  runs  up  toward  the  neck,  then 
turns  and  descends  along  the  spine  and  divides  in  the  lower  abdomen  into 
the  two  common  iliac  arteries. 

Coronary  Arteries. — Just  after  leaving  the  heart  it  sends  the  two 
coronary  arteries  to  the  heart  muscle.  Then  as  it  arches  through  the 
chest  it  gives  off  on  the  right  side  the  innominate  artery  and  on  the  left 
Bide  the  left  common  carotid  and  the  left  subclavian  arteries.  The  In- 
nominate divides  into  the  right  common  carotid  and  subclavian  arteries. 

Cardiacs — The  carotids  (Fig.  44)  run  up  the  neck  to  the  top  of  the 
larynx  where  they  divide  into  the  external  carotid  ■which  supplies  the  out- 
side of  the  head  and  the  internal  carotid  which  supplies  the  brain,  ear 
and  eye. 

Subclavian — Tlie  subclavian  (Fig.  45)  supplies  the  chest,  neck  and 
upper  extremity;  when  It  reaches  the  armpit  it  is  called  the  axillary  artery 
and  in  the  arm  It  is  called  the  brachial.  This  trunk,  called  subclavian  axil- 
lary and  brachial,  according  to  its  situation,  gives  off  numerous  branches 
to  the  various  structures  of  the  shoulder  and  arm.  At  the  elbow  it  divides 
into  the  radial  and  ulnar  branches.  The  brachial  lies  on  the  inner,  pro- 
tected side  of  the  arm  just  beneath  the  biceps  muscle.  It  is  important  to 
know  its  location  when  making  pressure  to  stop  hemorrhage  lower  down 
the  arm. 


THE   ^VKTEKIES. 


109 


Radial  Artery. — The  radial  artery   (Fig.  46)   from  the  bend  of  the 
elbow  down  the  radial  side  of  the  arm  to  the  wrist,  where  it  is  frequently 


Figure   43. 


Figure  43. — ARTER1E.S  OF  HEAD.  1.  common  carotid;  2.  Internal  carotid;  3.  external 
carotid:  4.  occipital;  5,  superior  thyroid;  6,  trapezius;  7.  ]'n\gua.l;  8,  sterno-mastoid;  9.  facial; 
10,  temporal;  11.  submental;  12,  transverse  facial;  13,  inferior  labial;  15,  inferior  coronary; 
17,   superior  coronary;   19,  lateral  nasal;   21,   angular. 


felt  to  determine  the  character  of  tHe  pulse;  it  then  winds  around  the 
base  of  the  thumb,  enters  the  palm  between  the  thumb  and  metacarpal 
bone  of  the  index  finger  and  forms  an  arch  (deep  palmar  arch),  which 
sends  branch  to  the  thumb,  index  finger  and  palm. 

Ulnar  Artery — The  ulnar  artery,  larger  than  the  radial,  passes  down 
the  inner  side  of  the  forearm,  giving  off  branches  to  the  muscles.  In  the 
palm  it  also  describes  an  arch  (superficial  palmar  arch)  which  sends 
branches  to  the  fingers. 

Thoracic  Aorta. — The  portion  of  the  aorta  in  the  thorax  is  called  tho 
thoracic  aorta,  that  in  the  abdomen  tlie  abdominal  aorta.     The  thoracio 


110 


ANATOMY    AND    PHYSIOLOGY. 


aorta  supples  the  pericardium,  lungs,  oesophagus  and  intereostal  strnetures 
with  nourishment. 

Abdominal  Aorta — The  abdominal  aorta  (Fig.  47)  supplies  the 
diajihragiu,  stomach,  liver,  spleen,  intestines,  kidneys,  ovary  or  testicle 
and  muscles  of  the  abdominal  wall  by  branches  whose  names  correspond 
to  the  organ  it  supplies. 

Common  Iliacs. — Opposite  the  fourth  lumbar  vertebrre  the  aorta 
divides  into  the  two  common  iliacs,  short  trunks  which  again  divide  into 
the  internal  and  external  iliac  arteries,  giving  off  no  branches. 


Figure   44. 

Figure  44. — ARTERIES  OF  NECK.  1,  occipital  artery;  2,  facial  vein;  3,  spinal  acces- 
sory nerve;  4.  facial  artery;  5,  internal  jugular  vein;  6,  hypoglossal  nerve;  7,  communicans 
noni  nerve;  8,  lingual  artery;  9,  pneumogastric;  10.  superior  laryngeal  nerve;  11,  pliren-o; 
12,  superior  thyroid  artery;  13,  sterno-mastoid;  14.  common  carotid;  15,  clavicle;  16,  sterno- 
hyoid;  17,   subclavian;    18,   orao-byoid;    19,   subclavian;    20,   sympathetic  ganglia;    21,   apex   lung. 

The  internal  iliac  dips  into  the  pelvic  cavity  and  divides  into  two 
trunks;  the  anterior  gives  off  branches  to  the  bladder,  rectum,  anus, 
genital  organs,  buttocks  and  upper  part  of  the  thigh;  the  posterior  trunk 
sends  branches  to  the  buttocks,  saciiim  and  muscles  in  the  pelvis. 


THE   AKTEKIES. 


Ill 


External  Hiac. — The  external  iliac   (Fig.  48)   rims  across  the  pelvis 
and  escaping  below  Poupart's  ligament  is  continued  down  the  thigh  as 


Figure    4 


Fieure  45. — ARTERIES  OF  ARM.  1.  axillary  artery;  2.  thoracica  acromialls;  3,  su- 
perior thoracic;  4,  subscapular;  5,  inferior  scapular;  6.  7,  branches  to  the  teres  and  sub- 
scapularis;  8,  anterior  circumflex;  9,  brachial;  10,  profunda;  11.  posterior  circumflex;  12, 
profunda;    13.    muscular    branches;    14,    branches    to    brachialis    internus;    15,    recurrent    ulnar. 

Figure  46. — DEEP  DISSECTION  FRONT  OF  FOREARM.  1.  supinator  longus;  2,  ulnar 
nerve;  3,  brachialis  anticus;  4,  biceps;  5,  musculo-spiral;  G,  median  nerve;  7,  posterior  inter- 
osseous nerve;  8,  pronator  teres  and  flexor  carpi  radialis;  9,  extensor  carpi  radialis  longior; 
10,  brachial  artery;  11,  supinator  brevis;  12.  flexor  sublimus  digitorum;  13,  13.  radial  nerve; 
14,  flexor  carpi  ulnarls;  15,  extensor  carpi  radialis  brevier;  16,  ulnar  artery;  17,  radial  origin 
of  flexor  sublimus  digltorum;  18,  flexor  profundus  digltorum;  19,  pronator  teres;  20,  dorsal 
branch  ulnar  nerve;  21,  radial  artery;  22,  deep  branch  ulnar  nerve;  23.  flexor  longus  polUcls; 
24,  abductor  minimi  dlglti;  25,  anterior  interosseous  nerve;  2fi,  digital  branches  of  ulnar 
nerve;  S7.  supinator  longus;  28.  one  of  lumbrlcalcs;  29,  pronator  quadratus;  31,  flexor  carpi 
radialis;    33,    digital    branches    m-rlian    nerve;    3  5,    abductor    poIUcia. 


112 


ANATOMY    AN1>    PIIYSIOLOOY. 


the  femoral  artery.     It  gives  off  two  largo  branches  to  the  muscles  of 
the  belly. 

Femoral  Artery. — The  femoral  artery  runs  a  straight  course  clown  tho 
thigh  from  the  middle  of  the  groin  to  the  lower  third  of  the  fem.ur,  where 


kmw 


Figure    47. 


Figure    48. 


Figure  47. — ARTKRIES  OF  THIGH.  1.  aorta;  2,  common  iliac;  3,  external  Iliac;  4, 
epigastric;  5.  circumflex  iliac;  6,  interna!  iliac;  7,  ilio-lumbar;  8,  gluteal;  9,  obturator;  10, 
lateral  sacral ;  11,  vesical  arteries;  12,  middle  hemorrhoidal ;  13,  Internal  pudic;  14,  ischiatlc; 
15,    femoral ;    16,    foramen    for    femoral ;    17,    profunda;     IS,    internal    circumflex. 

Figure  4S. — ARTERIES  OF  LEG.  1,  extensor  proprius  pollicis;  2,  articular  arteries;  3, 
anterior  tibia;  4,  5,  same  artery;  6,  recurrent  branch;  7,  8,  muscular  branches;  9,  dorsalia 
pedis;    10,   external   malleolar  artery. 


it  passes  throngli  an  opening  in  the  muscles  and  becomes  the  popliteal. 
After  giving  off  several  small  vessels  to  the  muscles  of  the  tliigh  it  sends 
out  a  larc'c  Irunk,  the  profunda,  which  gives  off  two,  the  circumflex  and 
three  perforating  branches,  which  supply  the  muscles. 


THE  VEINS.  113 

Popliteal  Artery — The  popliteal  is  the  continuation  of  the  femoral 
running  in  the  hollow  behind  the  knee  joint,  dividing  just  below  the  knee 
joint  into  the  anterior  and  posterior  tibial  arteries. 

Anterior  Tibial — The  anterior  tibial  passes  forward  between  the 
bones  of  the  leg  at  its  upper  part,  passes  down  the  front  of  the  leg,  and 
on  the  front  of  the  foot,  becomes  the  dorsalis  pedis. 

Dorsalis  Pedis. — The  dorsalis  pedis  runs  along  the  back  of  the  foot 
and  terminates  in  the  artery  of  the  great  toe ;  it  gives  off  branches  to  the 
tarsus  and  metatarsus,  the  latter  forming  an  arch  and  giving  branches  to 
the  toes. 

Posterior  Tibial.^ — -The  posterior  tibial  descends  along  the  inside  of 
the  back  of  the  leg  to  the  hollow  behind  the  inner  ankle,  where  it  divides 
into  the  two  plantar  arteries.  It  gives  branches  to  the  muscles  of  the  leg, 
tibia  and  ankle. 

Plantars — The  internal  and  external  plantar  arteries  crossing  the 
foot  form  an  arch,  from  which  branches  are  given  to  the  toes,  in  a  manner 
analagous  to  those  in  the  baud. 

Pulmonary  Artery — From  the  right  ventricle  of  the  heart  arises  the 
pulmonary  artery,  which  conveys  the  impure  blood  to  the  lungs  to  be 
puriiied. 

THE  VEINS. 

Vein  Function — After  the  blood  flows  through  the  capillaries  it  is 
collected  by  the  veins,  which  are  made  by  small  branches  joining  to  form 
larger  branches  and  these  again  joining  larger  trunks,  and  so  on. 

Vein  Structure — The  veins  have  three  coats,  like  the  arteries,  but 
are  thinner,  less  elastic,  and  when  empty  collapse.  They  have  valves 
at  intervals  to  prevent  the  backward  flow  of  blood. 

Jugular  Vein — The  small  veins  of  the  exterior  of  the  head  follow  the 
arteries  and  have  similar  names.  They  empty  into  the  external  jugular 
which  runs  do-\vn  the  neck  and  empties  into  the  subclavian  vein. 

Internal  Jugular. — The  internal  jugular  receives  the  veins  from  the 
interior  of  the  cranium,  passes  down  the  neck  with  the  carotid  artery  and 
imitcs  with  the  subclavian  vein  to  form  the  innominate  vein. 

Innominate  Veins — The  two  innominate  veins  are  in  the  chest  and 
join  to  become  the  superior  vena  cava. 

Veins  of  Upper  Extremity. — The  veins  of  the  upper  extremity  (Fig. 
49)  besides  those  accompanying  are  a  radial,  an  anterior  and  posterior 
idnar  and  a  median  vein.  They  collect  the  blood  from  the  hand  and  fore- 
arm, and  just  above  the  bend  of  the  elbow  the  ulnar  veins  unite  to  form 

joint  into  the  anterior  and  posterior  tibial  arteries. 
8 


114 


ANATOMY    AND    I'liySIOLOGT. 


the  basilic  vein,  wliich  passes  up  the  inner  side  o£  the  arm  and  empties 
into  tlie  axillary  vein. 

Eadial  Vein. — The  radial  vein  forms  the  cei)halic,  which  passes  up  the 


Figure  49. 


risure   50. 


Fleure  43. — VEIN'S  OF  UPPER  EXTREMITY.  1,  axillary  artery;  2.  axillary  vclna; 
3.  4,  basilic:  5,  point  where  median  basilic  joins  basilic;  6,  posterior  basilic  vein;  8,  anterior 
basilic  vein;  U,  point  where  cephalic  enters  axillary;  10,  portion  same  vein;  11,  point  where 
median    cephalic    enters    cephalic;    12,    lower    portion    cephalic    vein;    13,    median    cephalic    vein; 

14,  median    vein;    10,    anastomosing    branch;    16,    cephalica-poliicis    veins;    17,    veins    of    fingers; 

15,  lialmar  vein.s. 

Flf,'ure  GO. — VEINS  OF  LEG.  1,  saphenous;  2,  collateral  branch;  3,  anastomosis;  4, 
Internal  saphenous;  5,  origin  of  saphenous;  6,  anastomosing  branch;  7,  branches  on  back 
leg;  8,  internal  vein  of  foot;  1),  arch  veins  on  metatarsal  bones;  10,  branch  from  heel;  11, 
branches  on   sole   of   foot. 

outside  of  the  arm  and  winding  around  the  shoulder-joint  empties  Into 
the  axillary  vein. 

Median  Vein — Below  the  bend  of  the  elbow  the  median  and  a  branch 
from  the  deep  veins  empty  into  a  large  V-shaped  vein;  running  from  its 


BREATHING  ORGANS.  llg 

apex  into  which  these  veins  empty  it  unites  together  the  basilic  and 
cephalic  veins,  one  arm  being  called  the  median  basilic  and  the  other  the 
median  cephalic. 

Axillary  Vein. — The  axillary  vein,  in  the  armpit,  runs  up  to  form 
the  subclavian  which  joins  the  internal  jugular  to  form  the  innominate. 

The  internal  saphenous  vein  (Kg.  50)  commences  on  the  back  of 
the  foot,  and  running  straight  up  the.  inner  side  of  the  leg  and  thigh  joins 
the  femoral  vein  just  below  Poupart's  ligament. 

Saphenous  Vein. — The  external  or  short  sai^henous  vein  begins  at  the 
outer  side  of  the  foot,  runs  up  the  middle  of  the  calf  of  the  leg  and  empties 
into  the  popliteal  vein. 

The  deep  veins  follow  the  arteries  and  have  similar  names. 

Femoral  Vein — The  femoral  vein  receives  all  the  veinous  blood  from 
the  leg,  runs  with  the  femoral  artery  into  the  abdomen,  becomes  the 
external  iiiac  which  joins  with  the  internal  iliac  to  form  the  common  iliac. 
The  two  common  iliacs  join  to  form  the  inferior  vena  cava  which  runs 
up  the  spine  and  empties  into  the  right  auricle,  receiving  in  its  course  the 
various  abdominal  veins. 

Portal  Vein — The  veins  from  the  stomach,  spleen  and  intestines  are 
collected  into  a  short  trunk,  the  portal  vein,  which  enters  the  liver.  The 
blood  from  the  liver  is  collected  by  the  hepatic  vein,  which  empties  into 
the  inferior  vena  cava. 

Pulmonary  Veins — The  four  pulmonary  veins  start  as  capillaries  in 
the  walls  of  the  air  cells  of  the  lungs,  carry  pure  blood  and  empty  into  the 
right  auricle. 

EESPIRATORY  APPARATUS. 

In  order  to  reach  the  lungs  air  passes  through  the  nose,  pharynx, 
larynx  and  trachea,  which  warm  it  and  filter  it  of  impurities. 

The  Larynx. — The  larynx  (Adam's  apple)  is  the  organ  (Fig.  55)  of 
voice,  and  will  be  described  in  connection  with  disease  of  the  throat. 

Windpipe. — The  trachea  (windpii^e)  is  made  of  rings  of  cartilage, 
joined  by  connective  tissue.  It  is  five  inches  long  and  lies  just  beneath 
the  skin  of  the  neck  until  it  enters  the  chest,  where  it  divides  into  the  two 
bronchial  tubes,  one  going  to  each  lung.  These  divide  and  subdivide 
into  numerous  branches. 

The  Lungs — -The  lungs  are  conical,  slate  colored  in  adult  life  aud  are 
separated  in  the  middle  of  the  thorax  by  the  heart,  gullet  and  great 
blood-vessels.  The  outer  surface  of  the  lungs  is  convex  and  smooth,  the 
iiiner  surface  concave.     Above  it  extends  into  the  neck,  below  it  rests 


116 


ANATOMY    AND    PIITSIOT.OGT. 


upon  the  diaphragm.  The  riglit  Inng  is  the  larger  and  is  divided  int/> 
three  lobes,  the  left  into  two. 

Lung  Lobes. — Eacli  lobe  is  made  of  little  lobules  which  consist  of  a 
little  ramification  of  a  bronchial  tube  communicating  with  air  cells. 

Lunj  Membrane. — The  surface  of  the  lung  is  covered  by  a  smooth 
serous  uieuibrane,   the  pleura,  which  is  reflected  upon  the  walls  of  the 


Figure  65. — TRANSVERSE  SECTION  THORAX.  1,  anterior  mediastinum;  2.  internal 
mammary  vessels;  3,  triangularis  sterni;  4.  B,  phrenic  nerves;  6.  thoracic  duct;  7,  cesophagus; 
8,  vena  azygos  major;  9,  thoracic  aorta;  10.  sympathetic;  R.  V.,  right  ventricle;  R.  A., 
right   auricle;   P.    A.,   pulmonary   artery;    A.,   aorta;    C,   superior   vena  cava;    V.,    dorsal    vertebra. 

chest ;  the  intervening  space  contains  a  small  quantity  of  fluid  which  pre- 
vents friction  during  the  respiratory  movements. 

Breathing. — When  the  chest  is  enlarged  by  elevation  of  the  ribs  and 
descent  of  the  diaphragm  the  lungs  follow  the  chest  wall  and  expand,  air 
rusliing  into  them.  "When  The  muscles  relax  the  elastic  and  over-distended 
lungs  discharge  the  air  through  the  windpipe. 

Air  Vesicles. — In  the  air  vesicles  the  blood  is  separated  from  the  air 
bv  a  very  thin  partition  through  which  oxygen  passes  to  the  blood  cor- 
puscles. The  expired  air  contains  the  carbon  dioxide  and  other  imjjur- 
ities  with  wliieh  it  has  been  charged  while  in  the  air  vesicles. 

Oxygenized  Bload. — The  blood,  after  passing  through  the  lungs,  is 
a  brighter  red,  riclier  in  oxygen,  cooler  and  is  rid  of  its  impurities. 


NERVOUS  SYSTEM. 

Function  of  Nerves. — The  nervous  system  presides  over  all  functions 
and  harmonizes  them.     It  permits  the  environs  to  be  recognizable.     It 


NERVOUS  SYSTEM. 


117 


may  be  compared  to  a  tcIegTapli  system,  of  which  the  brain  is  the  central 
station,  to  a  rider  on  a  hors(\,  or  to  the  captain  of  a  stcamsliiji.  It  is 
divided  into  the  cerebro-spinal  system  (brain  and  spinal  cord  with  their 
nerves  which  presides  over  the  animal  functions,  motion,  sensation,  etc., 
and  the  sympathetic  system  which  controls  the  organic  functions,  nutri- 
tion, growth,  etc.).  The  sympathetic  system  is  composed  of  a  series  of 
ganglia  (large  mass  nerve  cells)  in  the  head  and  along  the  front  of  the 
gpine,  connected  by  nei-vous  cords. 

The  Brain. — The  brain  is  a  huge  mass  of  white  and  gray  nervous 
matter  combined  in  and  protected  by  the  cranium.     It  is  surrounded  by 


Figure  CI. 

Pi?:nre  61. — BAPR  OF  BRATN.  1.  2.  lonf^itudinal  fissure;  3.  anterior  lobes  cerebrum; 
4.  middle  lobe;  5,  fisfcure  Sylvius;  C,  posterior  lobe;  7,  infundibulum :  8,  its  body;  9,  corporo 
albicHntia;  10,  cinetitious  matter;  11.  crura  cerebri;  12.  pons  Varolii;  13,  medulla  oblongata; 
14,  posterior  prolongation  of  pons;  15,  middle  of  cerebellum;  16,  anterior  part  of  cerebellum; 
17,  its  posterior  part  and  fissure;  18,  medulla  spinalis;  19,  middle  fissure  medulla;  20,  pyra- 
midal body;  21,  reliform  body;  22,  olivary  body;  23,  olfactory  nerve;  24,  its  bulb;  25,  its 
external  root;  26,  middle  root;  27,  internal  root;  2S,  29,  optic  nerve;  30.  third  nerve;  31, 
fourth  nerve;  32.  fifth  nerve;  33,  sixth  nerve;  34,  facial  nerve;  3b,  auditory  nerve;  3C,  37, 
38,    eighth   nerve. 


three  membranes  Cmeninges)  :  the  dura  mater,  externally,  dipping  into 
the  fissures  to  form  the  falx  cerebri,  tentorium,  cerebelli  and  falx  cero- 
belli  which  separate  and  support  portions  of  the  brain;   the  arachnoid, 


118 


ANATOMY    AND    PIlYSIOT.OaT. 


the  serous  membrane,  supplying  a  fluid  whicli  acts  as  a  water  cushion  for 
the  brain ;  and  tlie  pia  mater,  the  layer  carrying  the  blood-vessels. 

Weight  of  Brain. — The  average  weight  of  the  brain  is  fifty  ounces 
in  males,  and  six  ounces  less  in  females. 

Divisions  of  Brain. — The  brain  is  divided  into  the  cerebrum,  cere- 
bellum, pons  varolii  and  medulla  oblongata. 

The  Cerebrum. — The  cerebrimi  is  the  largest  part  of  the  brain,  resting 
on  the  roof  of  the  orbit,  base  of  skull,  and  tentorium  cerebelli.     It  is 


Figure   e2. 

Figure  62. — NERVES  OF  FACE  AND  SCALP.  1,  attrahens  aurem;  2,  anterior  belly 
occlpito-frontalis;  3,  auriculo-lemporal  nerve:  4.  temporal  branches  of  facial  nerve;  5,  attolena 
aurem:  6,  supra-trochlear:  7,  posterior  belly  occlpito-frontalis;  8.  supra-orbital;  9,  retrahena 
aurem;  10,  temporal  branch  of  orbital  nerve;  11,  small  occipital  nerve;  12,  malar  branches 
•it  facial  nerve;  13.  posterior  auricular  nerve;  14,  malar  branch  of  orbital;  15,  great  occipital; 
16,  infra-orbital  branches:  17,  facial  nerve;  18,  nasal  nerve;  19,  cervico-facial  division  of 
facial;  20,  infra-orbital  nerve:  21,  branches  to  digastric  and  stylo-hyoid;  22,  temporo-facial 
division  of  facial:  23,  great  auricular;  24.  buccal  branches  of  facial;  25,  trapezius;  26,  buc- 
cinator nerve;  27,  splenius  capitis:  28,  masseter;  29,  sterno-mastoid;  30,  supra-maxillary 
branches  of  facial  nerve;  31.  superficial  cervical  nerve;  32,  mental  nerve;  33,  platysma;  34, 
Infra-maxillary   branches   of   facial    nerve. 

divided  into  lateral  halves  by  the  falx  cerebri.  The  halves  are  joined  by 
the  corpus  callosnm.  Internally  it  is  composed  of  white,  and  externally 
of  gray,  nervoiis  tissue.  The  gray  tissue  is  wrinkled  into  convolution  and 
is  the  active  portion  of  the  brain,  the  white  matter  conducting  the  nerve 
impulses  to  and  from  it.  It  is  the  seat  of  memory,  intelligence,  reason, 
■will,  motion  and  sensation. 


NEEVOrS   SYSTEM.  119 

The  Cerebellum — The  cerebellum  lies  beneath  the  posterior  portion 
of  the  cerebrum,  is  gray  outside  and  white  inside.  It  coordinates  mus- 
cular movements. 

The  pons  varolii  connects  the  various  parts  of  the  brain.  It  conducts 
impulses  to  and  from  the  brain. 

Medulla  Oblongata — The  medulla  oblongata  is  the  enlarged  upper 
end  of  the  spinal  cord  resting  in  the  cranium.  It  is  made  of  blended 
white  and  gray  tissue,  conducts  the  nei-ves  from  the  brain  to  the  spinal 
cord  and  contains  independent  nervous  centres  which  regulate  the  heart, 
lungs,  blood-vessels,  sweating,  etc. 

Nerves  of  Brain — The  brain  gives  off  twelve  nerves  on  each  side. 
The  nerves  pass  out  through  holes  (foramen)  in  the  skull  and  supply  the 
organs  of  sight,  smell,  taste  and  hearing,  and  also  motion  and  sensation  to 
certain  parts.  They  are:  the  olfactory  (smell),  optic  (sight),  motor  oculi 
(motion  to  eye),  patheticus  (motion  to  superior  oblique  muscle  of  eye), 


Figure  63. 

Figure  63. — FIFTH  NERVE.  1.  orbit;  2,  antrum  of  Hlghmore;  3,  tongue;  4,  lower  jaw; 
6,  Gasserian  ganglion;  6,  first  branch  of  fifth;  7,  seconrl;  8.  third;  9,  frontal  branch;  10,  lac- 
rymal  branch;  11,  nasal  branch;  12,  internal  nasal  nerve;  13,  external  nasal;  14,  external 
and  internal  frontal  nerve;  15,  infra-orbital;  16.  posterior  dental  branches;  17.  middle  dental; 
18,  anterior  dental;  19,  terminating  branches  infra-orbital  nerve;  20,  orbital  branch;  21, 
ptyregoid  nerve;  22,  five  anterior  branches;  2.1,  lingual  branch;  24,  inferior  dental;  2.'»,  mental 
branches;     26,    superficial    temporal    nerve;    27,    auricular    branches;     28,     mylo-hyoid. 

trifacial  (sensation  to  face,  motion  to  cliowing  muscles  and  nerve  of  taste), 
abduces  (rolls  eye  out),  facial  (motion  to  face),  auditory  (hearing), 
glosso-pharyngeal    (taste    and    sensation),    pneumogastric    (presides    over 


120 


ANATOMY    ANU   PHYSIOLOGY. 


swallownng,  heart,  lungs,  otc-.),  s])inal  accessory  (motion  to  nmscles.  neck 
and  liack  and  the  hypoglossal  (motion  to  tongue). 

Spinal  Cord.— ihe  spinal  cord  is  a  long  tail  hanging  from,  the  back 


Figure   64. 


Figure  64. — NINTH,  TENTH  AND  ELEVENTH  NERVE.<?.  1,  Gasserian  ganglion;  2, 
internal  carotid;  3,  pharyngeal  branch  of  pneumogastric;  4.  glosso-pharyngeal ;  5,  lingual; 
6.  spinal  accessory;  7.  middle  constrictor  of  pharynx;  S,  internal  jugular  vein;  9,  superior 
laryngeal  nerve;  10.  ganglion  of  pneumogastric;  11.  hypoglossaJ;  12,  ditto  communicating 
with  eighth  and  first  cervical;  13.  external  laryngeal;  14,  second  cervical;  15,  pharyngeal 
plexus;  Ifi,  superior  cervical  ganglion;  17,  superior  cardial!  nerve;  18.  third  cervical;  19. 
thyroid  body;  20.  fourth  cervical;  21.  recurrent  laryngeal;  22,  spinal  accessory;  23,  trachea; 
24.  middle  cervical  ganglion;  25.  middle  cardiac  nerve;  E6.  phrenic;  27,  left  carotid;  28, 
brachial  plexus;  29,  phrenic;  30.  inferior  cervical  ganglion;  31.  pulmonary  plexus;  32,  aorta; 
S3,   oesophageal   plexus;    34,   vena  azygos  ST.,   vena  azygos   minor;    36,   gangliated    cord 

of  sympathetic. 


THE  SPINAT>  CORD. 


121 


of  the  brain  and  contained  in  the  spinal  canal.     It  is  sixteen  to  eighteen 
inches  long  and  surrounded  by  three  nienibranes  like  the  brain. 

Upper  Section. — Upon  section  the  cord 
(Fig.  59)  is  seen  to  be  composed  externally 
of  white  nervous  tissue,  and  internally  of  the 
gray,  which  is  arranged  somewhat  in  the 
shape  of  the  letter  H.  The  cord  is  divided 
by  two  antero-posterior  fissures  into  two 
eqiial  lateral  halves,  which  are  united  in  the 
centre  by  a  bridge  of  gray  matter. 

The  spinal  cord  is  a  great  nerve  cable 
carrying  fibres  to  and  f roiu]  the  brain ;  it  also 
coordinates  motion,  presides  over  the  nutri- 
tion of  certain  parts  and  contains  inde- 
pendent nervous  centre. 

From  the  anterior  horn  of  the  gray 
matter  arises  the  motor  roots  of  the  spinal 
nerves  and  from  the  posterior  horn  the 
sensory  roots. 

Spinal  Nerves. — Each  spinal  nerve,  of 
which  there  are  thirty-one  pairs,  consists  of 
the  anterior  or  motor  and  the  posterior  or 
sensory  root.  These  unite  within  the  spinal 
canal  and  form  a  single  cord  (Fig.  05), 
which  passes  through  the  opening  between 
the  vertebra;  and  divides  into  two  trunks, 
one  for  the  anterior  and  the  other  for  tlie 
posterior  surface  of  the  body. 

Cervical  Plexus. — The  anterior  branches 
of  tlie  four  upper  cervical  nerves  iinitc  with 
each  other  to  form  the  cervical  plexus  which 
gives  off  branches  to  the  side  of  the  head, 
neck,  shoulders,  chest  and  diaphragm.     The 


Figure    53. 


Figure 
CORD.        1 


<^ 


anterior    branches    of    the    fifth,    sixth    and 


59.  —  BRAIN  and 
1,  hemisplieres  of 
cerebrum;  2,  great  middle  fis- 
sure; S,  cerebellum:  4.  olfactory 
nerves;  5,  optic  nerves;  6,  cor- 
pora albicanlia;  7,  motor  oculi; 
8,  pons  Varolii;  9,  fourth  nerve; 
10,  medulla  oblongata:  11,  11, 
nKiduUa  spinalis;  12,  12,  spinal 
nerves;    IZ,    Cauda   equina. 


seventh  cervical  nerves  unite,  the  fifth  re- 
ceiving a  branch  from  the  fourth  ;  the  eighth 
cervical  and  first  dorsal  nerves  unite;  these 

cords  form  the  brachial  plexus,  and  after  sending  nerve  trunks  lo  the 
muscles  of  the  neck  and  sides  of  the  chest  below  the  collar  bone,  these  two 
trunks  each  send  off  a  trunk  which  unite  to  fonn  a  third  or  posterior  trunk 


122 


ANATOMY    AND    PIIYSIOLOOY. 


■which  divides  into  two  branches,  supplying  the  muscles  and  skin  of  the 
outside  ami  l);'ck  of  the  arm,  forearm  and  hand. 

Inner  and  Outer  Trunks. — The  inner  and  outer  trunks  are  continued 
down  the  inside  of  the  arm,  and  again  each  sends  a  branch  to  form  a 


Figure    60. 

Figure  60. — VIEWS  OF  SECTION  OF  CERVICAL  CORD.  A,  anterior  surface:  B.  right 
side;  C,  upper  surface;  D.  nerve  roots;  1.  anterior  median  fissure;  2,  posterior  median  Iissure;  S. 
anterior  lateral  depression;  4,  posterior  lateral  groove;  5,  anterior  roots;  6,  posterior  roots; 
6',  ganglion;   7,  spinal   nerve;   7',   posterior  branch. 


middle  cord,  the  median  nerve.  The  external  cord  then  becomes  the 
rausculn-cntancous,  and  the  internal,  the  ulnar. 

Median  Nerve — The  median  nerve  (Fig.  66)  gives  o£F  branches  to  the 
muscles  and  to  the  skin  of  the  hand.  The  ulnar  nerve  is  placed  on  the 
inner  side  of  the  arm  and  supplies  the  forearm  and  hand.  The  musculo- 
cutaneous supplies  tlie  skin  and  muscles  of  the  forearm  and  wrist. 

Spinal  Nerves. — The  twelve  dorsal  spinal  nerves  send  branches  along 
the  ribs  and  supply  the  muscles  of  the  back. 

lumbar  Nerves — The  five  lumbar  nerves  send  posterior  branches  to 
the  muscles  of  the  back;  the  anterior  branches  iinite  to  form  a  plexus 
which  sends  branches  to  the  muscles  of  the  belly  and  the  genital  organs ; 
the  largest  branch,  the  crural  nerve,  is  distributed  to  the  front  of  the 
thigh. 

Sacral  Nerves — The  fifth  lumbar  joins  the  sacral  nerves  to  form  the 


NEEVES   OF  SPINE   AND   BACK, 


123 


sacral  plexus ;  its  largest  branch  is  the  great  sciatic  which  passes  down  the 
back  of  the  thigh j  dividing  at  the  knee  into  the  external  and  internal 


Figure  65. 


Figure    66. 


Figure  65. — DEEP  DISSECTION  OP  FRONT  OF  FOREARM.  1.  supinator  longue;  2. 
ulnar  nerve;  3.  brachial  is  anticus;  4,  bleeps;  5,  niueculo  spiral;  6,  median;  7,  posterior  In- 
terosseous; 8.  pronator  teres;  9.  extensor  carpi  radial  is  longlor;  10,  brachial  artery ;  11,  su- 
pinator brevls;  12,  flexor  subllmus  digitorum;  13.  radial  nerve;  14,  flexor  carpi  ulnarls;  15.  ex- 
tensor carpi  radialla  brevior;  16,  ulnar  artery;  17,  origin  flexor  subllmus  digitorum;  18,  flexor 
profundus  digitorum;  19,  tendon  pronator  teres;  20,  dorsal  branch  of  ulnar  nerve;  21.  radial 
artery;  22,  deep  branch  of  ulnar  nerve;  23,  flexor  longus  pollicis;  24,  adductor  minimi  dlgltl; 
25.  anterior  interosseous  nerve;  26,  digital  branches  of  ulnar  nerve;  27,  tendon  of  supinator 
longus;  28,  one  of  the  lumbricales  muscles;  29,  pronator  quad  rat  us;  31,  tendon  flexor  carp 
Iradialls;   33,   digital   branches  median  nerve;    35,   abductor  pollicis. 

Figure  C6.— NERVES  OF  THIGH.  1,  sympathetic  ganglia;  2,  third  lumbar;  3.  branches  to 
Illacus;  4,  fourth  lumbar;  5,  anterior  crural;  6.  lumbo-sacral ;  7,  branch  of  the  psoas;  8, 
obturator;  9,  external  cutaneous;  10,  nerve  to  pectlneus;  11,  branch  anterior  crural;  12,  su- 
perficial division  of  obturator;  13,  sartoriua  muscle;  14,  adductor  longus;  15,  branch  to  rectus; 
16.  deep  division  of  obturator;  17.  branches  to  vastus  externua  and  crureus;  18,  adductor 
brevls;  19,  branch  to  vastus  Internus;  20,  adductor  magnus;  21,  vastus  exlernus;  22,  internal 
saphena:   23.   rectus  femorlo;   24,   patellar  branch   of  saphena;    25,    vastus   Internus;    2C,'   gracilia. 


124 


ANATOMY    AND    IMIYSIOLOGY. 


popliteal  nerves;  these  are  contiuued  down  the  leg  as  the  anterior  and 
posterior  tibial  ncrvos  supplying  the  leg  and  foot. 


Figure    (;?. 


Figure    67a. 


Figure  67.— BUTTOCK  AND  BACK  OF  THIGH.  1.  gluteus  inaxlmus;  2.  gluteus  mediua; 
8,  glutial  artery;  4,  gluteus  minimus;  5.  nerve  of  obturator  Internus;  6,  pyrlformis;  7,  pudic 
nerve;  8,  small  sciatic  nerve;  9,  great  sacro-sclalic  ligament;  10,  obturator  internus;  11, 
Inft-rior  gluteal  nerve;  12,  tendon  obturator  internus;  13,  inferior  pudendal  nerve;  14,  quadratua 
femoris;  15.  gracllia;  16,  great  sciatic  nerve;  17,  adductor  magnus;  18,  insertion  gluteus  max- 
inius;  19,  origin  of  semltenilnosus  and  semimembranosus;  20,  short  head  of  biceps;  21,  semi- 
membranosus; 22,  tendon  of  biceps;  23,  tendon  of  semitendinosus;  24,  external  popliteal  nerve; 
25,  Internal  popliteal  neive;  26,  communicana  flbrelaris;  27,  popliteal  artery;  29,  gaatrocnemlua; 
31,   e.Nternal  saphinous   nerve. 

Figure  67a. — FUONT  OF  LEG.  1,  external  popliteal  nerve;  2,  anterior  tibial  artery;  3, 
muscuIo-cutancouH  nerve;  4,  anterior  tibial  nerve;  5.  peroneus  longus;  6,  tibia! us  anticus;  7, 
extensor  longus  digitorum;  S.  anterior  annular  ligament;  9.  pcrnncus  brevis;  10.  tendon  of  ex- 
tensor proprius  pollicis;  11,  extensor  proprius  poUicis;  12.  dorsal  artery  of  foot;  13,  musculo- 
cutaneous nerve;  14,  tendon  of  llbialns  anticus;  15,  internal  branch  of  musculo-cutaneous  nerve; 
16,  cutaneous  branch  of  anterior  tibial  nerve;  17,  external  branch  of  musculo-cutaneous  nerve; 
19,  deep  branch  of  anterior  tibial  nerve;  21,  external  liaphenous  nerve;  23,  extensor  brcvia 
digitorum. 


INDEX  TO  PART  I  OF  BOOK  III 

Preventive  Medicine 

The  Prevention  of  Disease  by  Elimination  of 
Disease  Carriers 

Part  I  of  Book  III  tells  of  how  disease  is  carried 
by  insects  and  other  seemingly  harmless  means. 

Consult  the  Part,  Index  and  the  Reference  In- 
dex, also  General  Index. 

SUBJECTS  OF  THE  TEXT 


Advice  of  Parents  to  Children  in  Sex- 
ual   Matters 143 

Bed    Bugs 138 

Bed   Bugs,   How   to    Destroy 138 

Body    Lice 139 

Breeding  Places  of  Flics 132 

Breeding  Places  of  Flics,  How  to  De- 
stroy      - 132 

Breeding  Places   of   Mosquitoes,   How 

to    Destroy    134 

Carriers  of  Disease 130 

Children,  Advice  Necessary  in  Sexual 

Matters     143 

Cockroaches    137 

Cockroaches,    How   to   Destroy 138 

Common   Carriers   of   Disease 130 

Crab  Lice    140 

Destruction    of    Erecding     Places    of 

Flies     132 

Destruction    of    Breeding    Places    of 

Mosquitoes    134 

Destruction   of   Cockroaches 138 

Destruction   of  Existing  Flies 133 

Destruction  of  Existing  Mosquitoes.  .135 

Destruction    of    Fleas 137 

Disease,   Elimination   of  Carriers  of..  127 
Disease    Prevented    by    Hcallhy    Con- 
dition      128 

Drinking    Cup    141 

Elimination    of    Breeding    Places    of 
Flics     132 


Elimination  of  Disease  Carriers 127 

Fleas     136 

Fleas,  How  to  Get  Rid  of 137 

Flies,   Breeding  Places  of 132 

Flies,  Elimination  of  Breeding  Places,  132 

Flies,  Manner  of  Getting  Rid  of 133 

Fly,    The    132 

Germ   Laden   Milk 130 

Gonorrhoea     143 

Head    Lice    139 

Health    as    Preventive   of   Disease 128 

Health,   How  to  Retain 128 

Insects  as   Carriers  of  Disease 131 

Itch   Mite,   The 140 

Lice    139 

Lice,   Body    139 

Lice,  Crab   140 

Lice,   Head    139 

Malaria  Carried  by  Mosquito 133 

Milk,    Germ-Laden     130 

Mosquitoes  as  Carriers  of  Malaria,  133 

Mosquitoes,  How  to  Destroy 135 

Mosquitoes,  How  to  Destroy  Breeding 

Places   of    134 

Mosquitoes,   IIow   They   Develop 134 

Opthalmia    143 

Public    Drinking    Cup 141 

Public  Towel    142 

Sexual  Advice  to  be  Given  Children,   143 

Syphilis  143 

Towel,  The  Public 142 


125 


Book  III. 


PREVENTIVE   MEDICINE. 

PAKT  I. 

THE  PREVENTION  OF  DISEASE  BY  ELIMINATION 
OF  DISEASE  CAERIERS. 

Wben  speaking  of  preventive  medicine,  we  include  the  methods 
used  by  physicians,  State  and  Federal  Government  Boards  of  Health, 
etc.,  to  prevent  the  spread  of  disease,  but  most  important  is  the  work 
done  by  past  and  present  men  of  science  and  their  willing  patients  who 
have  given  their  time,  labor,  and  in  many  cases,  their  lives  to  discover 
the  underlying  causes  of  disease,  for  the  latter,  like  everything  else  in 
this  world,  has  its  reasons  for  existence.  Thus  it  can  readily  be  under- 
stood that  disease  cannot  be  properly  prevented  when  the  underlying 
cause  is  unkown. 

Before  dissection  of  the  human  body  and  experiments  on  animals 
were  permitted,  man's  knowledge  of  his  own  body  and  disease,  its  causes 
and  symptoms  and  treatment  was  mere  giiesswork.  Thus  in  past  centuries 
the  arteries  were  thought  to  contain  air  instead  of  blood ;  disease  was 
believed  to  be  a  curse  from  heaven  or  the  king  and  everything  lay  in 
the  hands  of  the  Gods  as  to  whether  a  person  recovered  or  not. 

In  the  last  century,  man  began  to  awaken  from  his  sleep  and  by 
means  of  the  discovery  of  the  microscope  and  the  permission  to  experiment 
upon  living  animals  more  and  more  the  cause  of  disease,  its  transference 
from  one  animal  to  another  and  then  from  animal  to  man  and  man  to 
man  was  tried,  and  always  the  same  symptoms  occurred  in  the  animal 
or  man  into  which  the  blood  of  the  animal  suffering  from  the  original 
disease  had  been  placed  by  injection  into  their  blood,  etc.  By  these 
methods  gradually  the  cause  of  disease  was  found  to  be  due  to  the  presence 
of  minute  living  bodies  called  bacilli  or  germs,  etc.,  which  were  only 
visible  when  the  blood,  spit,  urine,  etc.,  of  the  sufferer  was  examined 

(127) 


128  PREVENTION   OF    DISEASE. 

under  the  microscope  nnd  from  tins  beginning  are  due  the  marvelous 
results  of  the  present  day  in  the  prevention,  treatment  and  cure  of  disease. 

Health. — Disease  can  be  prevented  by  the  individual  doing  everything 
in  his  power  to  keep  in  the  best  physical  condition.  Disease  is  a  common 
enemy  of  all  of  us,  waiting  to  destroy,  but  Nature  is  in  league  with  us 
if  we  obey  her  laws.  With  a  normal  body  and  pure  blood  should  the 
invader  arrive,  the  fight  is  on  our  side.  But  once  the  body  is  weakened 
by  heredity  as  a  result  o^  :ur  parent's  or  forefather's  neglect  of  the 
body,  through  the  abuse  of  alcohol,  tobacco  or  immoral  living,  lack  of 
exercise,  overeating  and  loss  of  sleep,  overwork  or  lack  of  work  or 
improper  food,  then  will  the  soil  be  fertile  for  the  planting  of  the  germs 
of  disease.  When  exposed  and  once  planted  the  fight  will  be  in  their 
favor,  as  the  rundown  body  will  not  have  sufficient  vitality  to  overcome 
the  invader  and  sickness  and  death  result. 

How  Can  We  Keep  Healthy? — The  best  answer  to  that  question  is, 
to  be  the  child  of  healthy  parents  and  come  from  a  sturdy  stock.  To  be 
nursed  at  the  mother's  breast  and  raised  out  of  doors  in  the  sunshine 
and  fresh  air,  to  sleep  with  plenty  of  air  in  the  room  at  night.  To  have 
&  natural  movement  of  the  bowels  once  a  day.  And  through  childhood 
to  receive  three  meals  a  day  consisting  of  pure  wholesome  food,  plenty 
of  milk,  free  from  germs,  pure  water  and  sleep  from  ten  to  twelve  hours 
a  night  throughout  childhood,  depending  on  the  age.  To  play  and  do 
work  which  will  be  in  the  air  and  develop  the  muscles  gradually.  Every 
child  should  be  vaccinated  any  time  after  the  sixth  month  and  repeat 
at  the  seventh  year,  to  be  done  at  once,  in  addition  during  an  epidemic 
of  small  pox.  It  is  not  necessary  or  right  for  a  child  to  have  scarlet 
fever,  measles,  diphtheria,  etc.,  as  so  many  people  think.  They  are  often 
followed  by  deafness,  heart  disease,  Tiervous  diseases  and  paralysis  which 
Nature  never  meant  to  inflict  a  child  with  to  go  through  life. 

Children's  teeth,  eyes  and  throat  should  be  examined  at  intervals  and 
many  defects  corrected.  The  tonsils  and  adenoids  (growths  which  stop 
up  the  nose  and  prevent  air  being  breathed  properly)  should  be  removed. 
Enlarged  tonsils  often  cause  deafness  by  preventing  air  from  the  throat 
reaching  the  ear  cavity  due  to  stopping  the  opening  of  the  Eustachian 
tube  which  leads  from  the  throat  to  the  ear. 

Children  should  not  be  taught  too  many  branches  at  school.  Every 
school  should  be  well  lighted  with  plenty  of  fresh  air.  Many  of  the 
smaller  schools  are  now  being  built  on  open  roofs  of  buildings  in  large 
cities  or  on  platforms  placed  out  of  doors  with  just  a  roof  overhead  to 


HOW    MAY    ADULTS    RTSMAIN    ITEAI.THY  ?  129 

protect  the  children.  All  schools  should  be  held  in  the  open  where 
possible.  There  is  absolutely  no  chance  of  cold  if  the  children  are  warmly 
dressed  and  exj^eriments  have  i^roven  that  the  children  are  healthier,  more 
attentive  and  mentally  efficient  where  they  have  been  in  school  in  the 
open  air. 

How  May  Adults  Remain  Healthy? — In  this  day  and  generation  the 
struggle  for  existence  is  becoming  more  and  more  complex,  the  occupations 
are  more  enacting  and  confining,  exposure  to  accidents  more  frequent, 
due  to  modem  machinery  and  its  difficult  handling.  Competition  in  all 
lines  is  great  and  therefore  more  strain  is  put  upon  the  brain  and  nerves 
of  man  in  all  walks  of  life.  This  leads  in  time  to  state  of  "Overwork," 
nervous  prostration  or  worry,  if  the  individual  has  not  the  physical 
strength  to  stand  the  battle  or  fails  to  keep  himself  in  a  normal  state 
of  body  and  mind  by  carefiil  living. 

When  in  the  latter  condition,  man  is  a  suitable  soil  for  development 
of  disease  which  makes  short  work  of  the  rundown  system,  and  such  a 
person  when  exposed  to  disease  or  accident  is  very  apt  to  succumb  imless 
some  reseiTe  vitality  comes  to  the  aid  of  him  or  Ler  and  the  physician 
or  surgeon  In  attendance  in  the  ^Ineven  battle  for  life. 

Man  can  keep  his  health  and  thus  prevent  disease  "by  Insisting  on 
getting  the  best  and  purest  of  foods,  working  In  factories  or  shops,  dairies, 
bams,  etc.,  which  are  well  lighted  and  ventilated,  free  from  dust,  smoke, 
irritating  vapors  from  paints,  gases,  acids,  etc.  By  insisting  upon  regular 
working  hours,  eight  hours  sleep,  dry  and  warm  clothing  If  exposed  during 
outdoor  work,  but  not  too  warmly  dressed  for  indoor  work.  Tea  or 
coffee  In  moderation  Is  not  harmful.  Xight  beers,  Porter,  Stout,  Ale; 
•wines,  as  Sierry,  Port,  Claret,  without  strong  preservatives  or  alcohol, 
except  In  small  proportions,  are  not  harmful  and  refresh  and  cheer  the 
tired  nerves.  Whiskey,  brandy,  cognac,  gin,  except  as  medicine,  are 
absolutely  harmful  and  the  whiskey  which  the  Government  allows  to  bo 
sold  In  this  country  Is  a  disgrace  and  a  poison.  More  and  more  corpora- 
tions and  business  men  are  inr'sting  on  their  employees  abstaning  from 
its  use.  It  causes  a  sense  of  stimulation  or  well  being,  which  Is  temporary 
and  Is  soon  followed  by  a  sense  of  depression  which  can  only  be  relieved 
by  a  renewal  of  the  dose  and  thus  stupid  man  continues  to  be  temporarily 
stimulated,  while  the  total  effect  of  his  Imbibing  Is  to  lower  his  vitality, 
destroy  his  mind,  cloud  his  judgment  and  render  him  vicious;  ruin  his 
appetite  by  Its  action  upon  his  stomach,  harden  his  liver  and  destroy 
his  kidneys. 


J.3Q  PREVENTION   OF    DISEASE. 

COMMON  CARRIEKS  OF  DISEASE. 

Why  is  it  that  Disease  Spreads? — It  has  been  found  by  scientists  that 
certain  definite  living  bodies  (germs)  are  tlie  cause  of  certain  diseases, 
as  tuberculosis,  smallpox,  typhoid  fever,  diphtheria,  etc. ;  and  other  diseases 
must  be  caused  by  other  undiscovered  bodies,  which  will  some  day  be 
known.  These  minute  living  bodies  are  active  and  give  off  poisonous 
material  which,  destroys  the  tissues,  organs,  etc.,  of  the  body.  When  a 
person  is  ill,  these  germs  arc  being  continually  thrown  off  in  the  waste 
materials  of  the  body,  in  the  spittle,  bowel  movements,  sweat,  saliva, 
urine,  etc.  If  these  products  of  disease  are  allowed  to  remain  in  a  vessel, 
the  carpets,  floor,  soil,  etc.,  they  dry  and  in  the  form  of  dust  are  blown 
about  in  the  air  of  the  house,  street  or  country  road.  If  they  come  in 
contact  with  clothing  or  household  furniture,  they  can  be  carried.  Should 
a  nurse  or  attendant  upon  a  case  be  careless  about  disinfecting  the  hands 
or  clothing  during  or  after  the  management  of  a  contagious  disease,  ho  or 
she  can  become  a  common  carrier  by  touching  food,  dishes,  clothing,  etc., 
used  by  other  members  of  the  family. 

Water  is  a  common  carrier  of  disease,  particularly  typhoid  fever, 
cholera,  etc.  Therefore,  to  prevent  the  spread  of  disease,  every  farmer, 
dair}^uan,  occupant  of  a  dwelling,  factory,  citizens  of  villages,  cities  and 
States,  should  see  that  they  have  a  clean,  water  supply  free  from  germs 
and  not  contaminated  by  dirty  water  or  refuse  from  a  toilet,  pig  pen, 
stable,  etc.,  which  might  contain  germs  carried  from  a  patient  or  animal 
suffering  from  any  one  of  the  contagious  diseases.  One  case  of  typhoid 
fever  along  the  edge  of  a  mountain  stream,  carelessly  managed,  thus 
permitting  bowel  movements  to  be  thrown  into  or  washed  into  the  stream 
by  rain,  melting  snow,  etc.,  could  cause  an  epidemic  in  every  village  which 
received  its  water  supply  from  that  stream  or  the  river  into  which  it 
emptied. 

Milk  can  be  a  common  carrier  of  disease,  such  as  tuberculosis,  typhoid 
fever,  scarlet  fever,  measles,  diphtheria,  etc.  Most  States,  however,  have 
protected  the  supply  of  milk  by  the  enactment  of  laws  covering  the 
inspection  of  cattle,  the  erection  of  well  lighted,  clean  and  ventilated 
dairies,  boiling  and  sterilization  of  all  utensils  used  in  its  handling,  even 
the  wearing  of  sterile  govras  by  the  milkers  and  attendants,  cleansing  of 
the  cows'  udders  before  and  after  milking  and  currying  and  brushing  the 
cattle  and  covering  them  with  light  blankets.  Milk  shoidd  be  kept  at 
even  temperature  after  being  placed  in  sterile  cans  to  prevent  the  forma- 


INSECTS  AS   COMMON   CAEEIEES.  131 

tion  of  germs  wbicli  will  develop  even  in  transit  to  the  consumer  in  the 
country  or  by  train  or  in  the  milk  bottles  prior  to  city  delivery.  Eail- 
roads  are  compelled  in  some  States,  and  should  be  in  all  States,  to  furnish 
refrigerator  cans  with  ice  and  the  dealers  in  the  city  should  particularly 
during  the  warm  weather,  have  a  refrigerator  or  ice  in  the  delivery  wagons 
to  maintain  an  even  temperature  for' all  milk  delivered. 

How  Can  the  Housewife  Protect  Her  Children  from  Drinking  Germ- 
Xaden  Milk? — First  make  sure  that  the  dairy  from  which  the  milk  is 
supplied  is  clean  and  up-to-date  and  the  city  dealer  delivers  the  milk  at 
her  doorstep  in  clean  bottles.  Do  not  allow  it  to  sit  in  the  sun  in  the 
early  morning  in  warm  weather,  or  about  the  kitchen  at  any  time  of 
the  year,  but  place  it  immediately  on  ice  in  a  clean  refrigerator  imtil 
ready  to  use.  When  taking  a  certain  quantity  of  milk  out  of  the  bottle, 
if  for  the  baby  use  a  Chapin  dipper,  and  do  not  allow  it  to  stand  uncovered 
for  flies  to  contaminate.  Milk  may  also  be  contaminated  by  water  from 
any  source  of  pollution  if  dairy  utensils  are  carelessly  washed  with  a 
supply  of  water  from  an  infected  water  supply  as  any  dirty  well  or  one 
contaminated  by  cess  pool,  out-house,  manure  pit  which  is  infecting 
water  through  the  soil  or  from  drainage. 

It  is  absolutely  vital  to  a  country  to  protect  its  milk  supply  as  two 
thirds  of  the  deaths  under  two  years  of  age  are  traceable  to  either  germ- 
laden  milk  from  dairies  or  not  properly  handled  by  dealers,  nurses, 
mothers,  etc.,  who  are  careless  or  too  ignorant  to  appreciate  the  danger 
of  allowing  baby's  milk  bottle  nipple  being  dirty,  contaminated  by  flies 
or  who  allow  a  millj  bottle  to  sit  in  the  hot  morning  sun, — result  a  sick 
baby,  followed  by  death. 

Insects  as  Common  Carriers — Great  strides  have  been  made  in  recent 
years  by  scientists  in  regard  to  the  fiirther  jii'evention  of  disease  by 
studying  the  life  habits  of  insects.  It  has  been  clearly  proven  that  the 
poison  or  germ  of  certain  diseases  are  carried  by  them,  such  as  tuberculosis, 
typhoid  fever,  bowel  complaints  of  children,  by  the  common  house  fly; 
malaria  and  yellow  fever  by  the  mosquito ;  the  bubonic  plague  by  the  rat 
flea,  of  which  there  are  several  varieties,  and  the  squirrel  flea,  of  which 
there  are  also  several. 

It  is  easily  understood  that  to  prevent  the  spread  of  a  contagious 
disease  from  one  individual  to  another,  the  precautions  are  not  complete 
unless  he  or  she  be  protected  against  either  the  bite  of  a  mosquito  or  flea 
which  has  received  into  its  own  blood  the  poison  or  the  germ  causing  the 
disease,  which  it  conveys  by  bitiug  another  person.     Flies  should  be  kept 


132  PEEVENTION  OF  DISEASE. 

out  as,  \>j  coming  in  contact  "with  the  spittle  or  discharges  from  ?,  patient, 
they  carry  the  germ  or  poison  iipon  their  feet,  etc.,  to  the  food,  milk, 
water  and  by  direct  contact  to  another  person. 

Thus  to  aid  in  the  prevention  of  disease,  the  numerous  Boards  of 
Health  of  City  and  State  have  issued  regulations  and  instructions  -nhcreby 
these  insects  can  be  destroyed  and  then  every  person,  sick  or  ■well,  can 
be  protected.  If  well,  the  fly  is  a  danger  by  bringing  disease  into  our 
home,  if  ill,  it  can  convey  our  disease  to  another  screenless  home  and 
start  an  epidemic. 

The  Common  Fly  (Musca  Domestica) — The  only  way  to  prevent  the 
fly  carrying  disease  is  to  destroy  his  breeding  place,  keep  him  out  of  the 
home,  etc.,  when  developed,  by  screens  and  swat  or  catch  by  fly  paper,  etc., 
every  one  seen  in  a  room. 

House  flies  are  a  danger  to  human  life.  They  are  born  in  filth, 
feed  upon  garbage,  sewage  and  waste  matter  of  all  kinds.  They  carry 
germs  on  the  proboscis  of  their  bodies,  and  a  single  fly  is  known  to 
have  carried  as  many  as  350,000  germs  and  given  them  off  into  the 
liquid  food  in  which  it  was  floating.  They  also  carry  numerous  germs 
inside  their  bodies  which  they  convey  to  food,  etc.,  in  their  vomit  and 
bowel  matter. 

Flies  can  carry  disease  germs  of  typhoid  fever,  consumption,  diar- 
rhoea, dysentery  and  other  diseases  from  a  sufferer  to  you.  They  come 
in  contact  with  your  food,  milk,  water,  etc.,  your  sleeping  child,  or  alight 
on  an  open  wound,  direct  from  the  garbage  can,  the  cuspidor,  the  spit 
in  the  street,  etc.,  from  decaying  animal  and  vegetable  matter  and  from 
the  sick  room.  Thus  every  individual  should  do  everything  possible  to 
aid  the  physician,  city  and  state  in  destroying  these  kno-\vn  carriers  of 
filth  and  disease  and  thereby  prevent  sickness,  due  to  carelessness  and 
indifference  by  permitting  flies  to  breed  and  live. 

How  to  Eliminate  the  Breeding  Places  of  Flies. — ^Flies  breed  by  laying 
larvse  or  eggs  which  can  be  seen  as  ilaggots  in  all  undisturbed  filth.  It 
requires  eight  days  for  the  millions  of  eggs  to  grow.  Keep  garbage 
can  tightly  covered,  protect  by  screens  so  that  flies  cannot  reach  the 
garbage.  See  that  garbage  is  collected  promptly  and  cleanly.  If 
you  live  in  the  country,  bura  or  bury  it.  Allow  no  fllth  or  decaying 
matter  of  any  kind  to  accumulate  in  or  near  your  premises.  Keep  stable 
clean,  place  manure,  old  straw,  etc.,  in  screened  pits,  vault,  or  in  boxes 
or  barrels,  which  should  be  well  covered.  Screen  all  privies,  vaults  and 
openings  to  cesspools  or  drainage  structures.    Src  that  they  do  not  overflow 


WHAT    TO    DO    TO    GET   EID    OF    FLIES.  133 

and  use  cbloride  of  lime  freely.  Pour  kerosene  into  drains,  keep  drainage 
systems  in  good  order  and  repair  all  leaks  at  once.  Destroy  sawdust 
cuspidors,  they  are  imsauitary.  Clean  cuspidors  daily  and  keep  a  five 
2)er  cent,  carbolic  acid  solution  in  them  all  the  time.  Permit  no  dirt 
to  accumulate  in  corners,  behind  doors,  back  of  radiators,  under  stoves, 
etc.  If  there  is  a  nuisance  iu  the  neighborhood,  notify  the  nearest  health 
authority. 

What  to  Do  to  Get  Rid  of  Flies — Screen  your  windows  and  doors. 
Do  it  early  in  the  Spring  before  fly  time  and  keep  it  iip  until  cold  weather 
comes.  Screen  all  food,  especially  milk.  Do  not  eat  food  that  has  been 
in  contact  with  flies.  Screen  the  baby's  bed  and  keep  flies  away  from 
the  baby's  bottle,  nipple  and  food,  rattle,  toys,  etc.  Keep  flies  away  from 
the  sick,  especially  those  ill  with  typhoid  fever,  scarlet  fever,  diphtheria 
and  tuberculosis,  etc.  Screen  the  patient's  bed.  Kill  every  fly  seen  to 
enter  the  sick-room.  Disinfect  all  discharges,  dressings,  bandages,  etc., 
from  the  patient  and  burn  where  possible.  Catch  all  flies  by  use  of  sticky 
fly  jJapers,  traps  and  liquid  poisons.  A  good  poison  to  destroy  flies  is 
two  teaspoonfuls  formaldehyde  in  a  pint  of  water  sweetened  with  sugar 
and  placed  in  saucers  throughout  the  house.  Be  sure  and  have  poisons 
out  of  reach  of  children  and  family  pets.  To  rid  an  infected  house  of 
flies,  burn  in  each  room  pyrethrum  powder.  Darken  the  room  allowing 
only  ray  of  light  to  enter  at  edge  of  window  shades.  Sprinkle  pyrethrum 
powder  over  hot  coals  and  carry  about  room.  The  flies  will  be  stunned 
by  the  fumes  and  can  be  readily  swept  up.  This  is  done  because  the  flies 
will  seek  the  light  to  escape  the  fumes  aud  fall  near  the  windows.  Swat 
the  fly  whenever  seen.  A  paddle  can  easily  be  made  to  kill  the  flies  with 
by  taking  an  oblong  sheet  of  vsdre  gauze  aud  nailing  it  to  a  stick  of 
suitable  length  for  a  handle. 

The  Mosquito. — The  mosquito  is  a  common  carrier  of  Yellow  Tever 
and  Malaria  or  "Chills  and  Fever"  as  it  is  sometimes  spoken  of  by  the 
public.  Malaria  is  caused  by  a  tiny  parasite  which  can  only  be  seen  by  tho 
microscope  in  the  blood  of  man  and  the  mosquito.  It  lives  and  multiplies 
in  the  blood  of  an  individual  suffering  from  the  disease. 

How  is  Malaria  Carried  by  the  Mosquito  ? — Let  us  imagine  that  a  man 
has  returned  from  some  malarial  country  and  takes  up  his  abode  in 
a  healthy,  yet  mosquito  infested  village.  This  man  may  be  fairly  over 
his  attack  yet  he  still  suffers  from  an  occasional  chill  with  fever.  lie 
has  no  screens  in  his  house,  nor  have  his  neighbors,  unless  previously  told 
to  follow  such  precautions.     A  female  mosquito  or  several  attack  him 


134  PREVENTION   OF  DISEASE. 

and  suck  his  blood  which  contains  these  tiny  parasites.  The  mosquito 
takes  millions  of  these  little  parasites  which  then  imdergo  a  development 
in  the  body  of  the  insect  and  can  be  seen  microscopically  in  the  stomach, 
intestine,  and  the  small  glands  in  its  mouth,  whicb  secrete  the  saliva. 
Now  let  us  follow  this  mosquito  and  see  what  harm  it  can  cause  in  a 
community.  It  flies  through  a  screcnless  door  or  window  and  lights  on 
the  arm,  etc.,  of  au  unsuspecting  neighbor.  In  biting  a  person  the 
mosquito  ejects  or  gives  off  its  saliva  into  tbc  woimd  to  aid  in  diluting 
the  blood  of  the  person  which  it  has  "bitten,  as  the  blood  is  too  thick 
to  be  sucked  up  througb  the  tiny  tube  in  the  bill  (proboscis)  of  the 
mosquito.  In  this  way  the  bite  of  the  female  mosquito  "whose  body  contains 
the  small  animal  parasites  whieb  cause  Malaria,  pass  by  means  of  the 
saliva  into  the  blood  of  the  person  during  the  act  of  sucking  up  the  blood. 
Thus  the  mosquito  sucks  up  the  blood  of  the  individual  and  in  exchange 
injects  into  his  blood  the  saliva  containing  the  parasites.  These  parasites 
multiply  in  the  blood  of  the  person  bitten  and  produce  poisons  which 
give  rise  to  the  chills,  fever,  aching  limbs,  etc.,  kncmi  as  Malaria,  Malarial 
Fever  or  "Ague,"  (chills  and  fever) .  It  can  readily  be  seen  bow  malaria 
will  spread  when  individuals  in  a  community  have  millions  of  parasites  in 
their  blood,  and  at  the  same  time  mosquitoes  are  carrying  around  in  their 
bodies,  millions  of  the  same  living  germs  whicb  they  suck  from  the  blood 
of  the  infected  person,  develop  and  inject  them  into  the  blood  of  every 
person  they  bite. 

How  Mosquitoes  Develop. — ^A  female  mosquito  lays  from  200  to  300 
eggs  at  a  time  and  always  in  standing  water,  as  the  eggs  must  have  still 
water  and  no  matter  how  filthy  the  water,  it  will  not  destroy  the  eggs 
or  prevent  their  development. 

How  to  Destroy  the  Breeding  Places  of  Mosquitoes Xo   breeding 

places,  no  eggs  and  consequently  no  mosquitoes.  When  we  consider  that 
one  female  mosquito  can  lay  200  to  300  eggs  at  a  time  and  then  figure 
the  number  of  living  pests  we  have  seen  in  one  evening,  it  can  readily  be 
seen  how  rapidly  they  can  develop  and  in  what  numbers  increase  if  their 
breeding  places  are  allowed  to  remain  about  any  premises.  Mosquitoes 
lay  their  eggs  in  standing  water,  such  as  is  found  in  cesspools,  drains, 
open  sewers,  catch  basins,  foul  street  gutters,  stable  yard  pools,  tin  cans, 
rain  barrels  or  any  object  which  holds  water.  In  from  a  few  hours  to  a 
day,  depending  upon  the  temperature  and  surrounding  conditions,  the 
eggs  open  and  what  we  know  and  have  seen  as  "wrigglers"  come  out  and 
can  be  seen  in  the  water  in  which,  the  eggs  have  developed,  as  tiny  slender 


HOW   TO   DESTROY    MOSQFITOES.  135 

living  bodies  l/^-inch.  in  leagth.  In  five  to  seven  more  days,  the  "wrig- 
glers" become  "tumblers."  In  auotlicr  five  to  seven  days  the  covering 
of  the  head  of  the  "tumblers"  cracks  and  the  fully  develoi^ed  adult  winged 
mosquito  comes  out  and,  in  the  case  of  the  female  of  the  species,  fiies 
oif  ready  to  annoy  and  bite. 

Every  individual  should  do  everything  possible  to  get  rid  of  all 
breeding  places.  Examine  your  premises  and  be  sure  that  they  are  free 
from  any  vessels,  etc.,  which  will  receive  and  contain  still  water  for 
one  week  or  longer,  that  will  afford  a  breeding  place  for  mosquitoes.  A 
loose  brick  causing  a  depression  in  the  pavement,  defective  plumbing, 
cups,  buckets,  barrels,  water  pans  in  chicken  yards,  etc.,  a  horse  trough, 
a  gutter  on  the  eaves  or  roof  of  a  house,  bottles,  barrels,  tin  cans,,  water 
Bpouts  out  of  repair  or  clogged  up  and  so  do  not  drain  properly.  These 
collectors  of  water  should  be  removed  and  all  plumbing,  drains,  roofs, 
etc.,  repaired. 

Mosquitoes  will  breed  indoors  as  well  as  outside.  Any  water  left  in 
clogged  sinks,  toilet  fixtures,  water  pitchers  in  bed  rooms,  slop  jars 
buckets,  tubs,  spittoons,  aquariums  withoiit  fish,  or  in  fact  any  vessel 
which  is  capable  of  holding  a  few  teaspoonfuls  of  still  water,  will  afford 
a  breeding  place  for  the  mosquito.  ISTeglect  to  remove  or  repair  the  above 
structures  is  only  allowing  a  large  eroj)  of  mosquitoes  to  develop  and  annoy 
you  and  your  neighbors  by  bites,  disturbing  your  comfort,  preventing 
rest  and  sleep  and  subjecting  you  to  the  malaria  and  yellow  fever  if 
you  are  in  a  district  where  these  diseases  are  knovsTi  to  exist. 

Every  citizen  should  use  his  influence  to  have  every  village,  city 
and  State  corjjoratlon  appropriate  money  to  eliminate  all  marshes  by 
filling  with  soil,  drain  all  stagnant  streams  and  have  kerosene  oil  spread 
on  the  surface  of  lakes,  ponds  or  any  other  body  of  stauding  water,  no 
matter  how  small.  The  object  of  using  oil  is  to  prevent  the  "wrigglers" 
and  "tumblers"  from  getting  air,  for  after  leaving  the  eggs,  they  require 
air  to  develop.  A  film  of  oil  prevents  the  "wrigglers"  from  getting  the 
needed  air  and  they  'are  destroyed  by  choking.  One  ounce  of  oil  is 
sufliclent  to  cover  15  square  feet  of  water.  Oil  should  be  applied  and 
removed  once  a  week  during  the  breeding  season.  When  standing  water 
must  be  kept,  screen  the  containers  or  keep  tightly  covered,  so  the  females 
cannot  deposit  their  eggs.  Screen  all  doors  and  windows.  Put  screens 
up  early  in  the  spring. 

How  to  Destroy  Existing  Mosquitoes — Kill  every  mosquito  seen  about 
the  house.     Every  mosquito  killed  in  the  winter  or  spring  will  lessen  the 


i36  PEEVENTION  OF  DISEASE? 

numljer  of  mosquitoes  in  the  summer  by  thousands.  TJse  a  paddle,  made 
of  an  oblong  sheet  of  ■wire  gauze  tacked  on  to  a  strip  of  wood,  to  serve 
as  a  handle,  to  kill  both  the  fly  and  mosquito  whenever  seen.  One  of 
the  best  means  of  killing  female  mosquitoes  (as  they  survive  from  one 
season  to  another)  is  to  begin  in  the  winter  or  early  spring  to  fumigate 
the  air  with  the  following  mixture : — Equal  parts  (by  weight)  of  carbolic 
acid  crystals  and  gum  camphor.  Liquify  the  carbolic  acid  crystals  by 
gentle  heat,  break  up  gum  camphor  into  small  pieces  and  then  pour  tho 
liquid  acid  slowly  over  the  camphor.  The  acid  will  dissolve  the  camphor 
completely  and  the  solution  formed  is  permanent  and  will  evaporate 
slightly  at  ordinary  temperatures.  To  fumigate  a  tightly  sealed  room, 
three  ounces  of  this  liquid  will  suffice  for  1000  cubic  feet  of  air  space. 
Place  it  in  a  tin  over  an  alcohol  or  other  lamp  and  in  addition  place  the 
lamp  on  a  tin  waiter  or  old  pie  plate,  beat  and  it  will  require  about  one 
half  hour  to  evaporate  these  three  ounces  of  liquid.  This  solution  is 
death  to  the  mosquitoes  and  files.  It  is  not  poisonous  to  man  and  is  not 
destructive  to  fabrics  and  materials,  furniture,  etc.  It  is  not  explosive, 
l)ut  is  inflammable  and  precaution  should  be  taken  to  prevent  fire. 
Mosquitoes  found  upon  the  ceilings  of  bedrooms  in  the  evening  may  be 
quickly  killed  by  taking  a  shallow  tin  cup  or  lip  of  a  tin  can,  tacking 
it  to  a  stick  and  then  fill  it  with  kerosene.  Place  quietly  under  the  resting 
mosquito  which  either  falls  into  or  flics  against  the  oil  and  is  killed. 
Burn  Chinese  punk  and  mosquitoes  will  be  driven  away  temporarily. 
Equal  parts  of  olive  oil  and  oil  of  citronella  applied  every  half  hour 
or  so  to  the  skin  of  the  face,  neck,  hands  and  ankles  will  keep  away 
mosquitoes.  This  method  is  useful  to  farmers,  himters,  lumbermen  or 
laborers  about  woods,  swamps,  etc.,  where  mosquitoes  are  an  annoying 
and  disease  carrying  pest. 

Fleas — There  are  one  hundred  varieties  of  this  pest  which  live  on 
dogs,  cats,  birds,  squirrels,  rats,  mice,  etc.  It  has  been  proven  that  fleas 
carry  the  germs  of  Bubonic  Plague,  which  has  caused  as  high  as  113 
.  deaths  in  119  cases  during  an  epidemic.  The  disease  was  found  to  be 
spread  by  means  of  rats,  mice  and  squirrels  of  all  species  and  the  flea 
(pulen  fasciatus)  in  the  fur  of  the  animals  was  the  medium  by  which 
the  disease  was  conveyed  to  human  beings  by  biting  them  and  injecting 
the  germs  of  Plague  into  their  blood. 

The  forms  which  pester  the  American  homes  are  the  House  Plea 
(Piilrn  Jrrltans),  the  Cat  Plea  (Pulen  Fclinius),  and  the  Dog  Plea 
(Pulcn  Canis).     Each  female  flea  deposits  from  eight  to  twelve  whitish 


TO    GET    ErO    OF    FLEAS.  137 

Ovoid  eggs  In  dust  or  lint,  under  carpets  and  the  larger  crevices  of  wood- 
■work.  In  the  summer  they  develop  in  about  four  weeks  from  the  egg 
to  the  adult  flea,  in  winter  they  develoj)  in  about  six  weeks.  Four  to  six 
broods,  as  a  rule  are  hatched  out  during  each  summer. 

The  House  Rea  occurs  in  dwellings,  breeding  in  bedding,  clothing, 
carpets,  window  curtains,  etc.  They  attack  their  victims  at  night.  The 
Cat  and  Dog  Flea,  though  they  annoy  only  their  respective  victims,  are 
as  troublesome  to  human  beings  as  the  human  flea. 

To  Get  Eid  of  Fleas — Eemove  and  clean  rugs,  etc.  Dust  Pyrethrum 
powder  into  all  cracks  and  crevices  where  dust  or  dirt  may  be  lodged  to 
destroy  the  larvse.  Scrub  the  floor  and  footboards  with  hot  soap  and 
■water  to  kill  the  adult  fleas.  To  eliminate  fleas  on  cats  or  dogs,  dust 
Pyrethrum  powder  into  the  hair.  The  fleas  will  fall  off  while  stupefied 
and  should  be  immediately  swept  up  and  burned.  Sleeping  places  of 
dogs  and  cats  should  be  cleaned  and  covered  with  a  carpet  or  matting 
that  can  be  shaken  into  an  open  fire  and  the  eggs,  larvse  and  fleas  with 
which  it  is  generally  covered,  destroyed.  During  an  epidemic  of  Bubonic 
Plague  destroy  all  rats,  mice,  stray  dogs  and  cats,  etc.,  and  protect  your 
touse  by  killing  all  fleas  whether  In  the  furnishings  or  on  your  family 
pets.  Flea  bites  are  painful  and  if  scratched  may  cause  an  abscess, 
followed  by  blood  poisoning.  The  pain  and  itching  of  a  flea  bite  can 
be  counter-acted  by  touching  the  wound  with  ammonia  water.  To  prevent 
infection,  bathe  the  wound  with  a  5  per  cent,  solution  of  carbolic  acid  in 
water  and  bandage  until  healed. 

Cockroaches. — Cockroaches  are  brownish  or  black  in  color,  broad  and 
flattened  in  shape  and  smooth  and  hard  to  the  touch.  All  cockroaches 
should  be  destroyed.  They  not  only  annoy,  but,  even  though  it  has  not 
been  proven,  they,  no  doubt,  carry  disease  germs  by  coming  in  contact 
with  discharges,  etc.,  from  ill  persons  and  convey  filth  and  germs  to  food, 
etc.  They  are  very  numerous  in  pantries,  kitchens  and  In  the  walls 
near  a  stove  and  fire  places.  They  are  apt  to  bo  abundant  In  oven  rooms 
or  bakeries  and  wherever  the  temperature  is  kept  above  normal.  They 
usually  appear  at  night  or  wherever  light  is  absent  and  thus  are  protected 
from  their  common  enemies.  Owing  to  their  shape  they  can  squeeze  into 
tiny  cracks.  They  scurry  away  when  surprised  and  generally  escape 
capture  or  destruction,  due  to  their  speedy  gait.  They  feed  on  animal 
matter,  cereals  and  any  food  material;  also  eat  woolens,  leather  cloth  and 
leather  bindings  of  books  ("due  to  the  presence  of  paste).  They  give  off 
a  fetid,  nauseous  odor,  which  persists  even  after  thorough  cleaning.     They 


138  PEEVENTION   OF   DISEASE. 

taint  food  supplies,  slain  slielves  and  dishes  and  -when  present  in  large 
numbers,  render  the  air  of  a  room  unbearable.  This  is  due  not  only 
to  their  excretion,  but  mostly  to  an  oily  liquid  secreted  in  the  scent  gland 
and  a  dark  colored  fluid  in  the  mouth.  They  will  destroy  bedbugs.  No 
contagious  disease  can  bo  said  to  be  properly  treated  or  isolated,  if  cock- 
roaches are  scurrying  about  the  -n^alls,  carpets,  food,  etc.,  of  a  sickroom 
and  allowed  to  persist  and  possibly  convey  the  germs  of  the  disease  to 
others  in  the  house  or  to  neighbors. 

How  to  Destroy  Cockroaches. — Take  a  quarter  of  a  toaspoonful  of 
phosporous,  two  level  tablespoonfuls  of  flour,  mix  and  make  into  paste 
with  well  sweetened  water.  Phosporous  is  very  inflammable  and  should 
not  be  allowed  near  fire  and  being  poisonous  must  not  be  placed  where 
children  and  family  pets  can  touch  or  eat  it.  Place  the  paste  where 
the  roaches  can  reach  it. 

Bed  Bugs — The  bedbug  is  a  small  but  plainly  visible  ovoid-shaped 
hug,  giving  off  a  peculiar  nauseous  odor.  It  is  of  a  reddish  brown  or 
rusty  color  with  some  discoloration  on  the  abdomen  and  is  furnished  with 
a  puncturing  or  sucking  apparatus.  The  eggs  are  tiny  white  oval  bodies. 
As  many  as  6  to  50  batches  are  laid  in  cracks  of  beds,  furniture,  picture 
frames,  wall  paper,  crevices  of  woodwork,  floors,  etc.  Each  batch  of  eggs 
develops  in  from  6  to  11  weeks,  and  several  batches  may  be  hatched  in 
a  season.  One  generation  succeeds  another  as  long  as  the  temperature 
remains  sufiiciently  elevated.  They  hibernate  during  cold  weather,  during 
which  season  the  insect  is  merely  stupefied  and  renews  its  activities 
upon  the  return  of  warm  surroundings.  It  is  found  in  the  dwellings 
of  man,  but  other  species  of  the  same  family  have  been  found  upon  birds, 
as  the  common  chimney  swallow,  pigeons  and  bats. 

The  bedbug  comes  out  at  night  and  begins  to  bite  and  annoy.  It 
conceals  itself  very  cleverly  and  qiiickly  in  the  day  time  or  when  surprised 
by  a  sudden  light  at  night.  It  lives  on  the  blood  of  man  particularly, 
but  can  exist  on  food  of  other  insects.  It  thrives  best  on  filth  and 
in  old  houses  can  keep  alive  without  food  for  a  year. 

Bedbugs  are  said  to  transmit  smallpox.  There  is  a  possibility  of 
tlioir  carrying  the  germs  of  typhoid  fever  and  leprosy,  but  this  fact  has 
not  been  proven  as  yet.  The  bite  is  poisonous  to  some  individuals,  result- 
ing in  inflammation  at  the  seat  of  the  bite.  This  is  supposed  to  be  due 
to  the  same  secretion  which  gives  the  characteristic  nauseous  odor. 

How  to  Destroy  Bed  Bugs. — Spray  with  pure  spirits  or  crude  tuvpen- 
tlue  or  benzine  by  using  an  ordinary  nose  and  throat  atomizer  which 


zias.  139 

can  be  bought  in  a  drug  store,  all  brass  or  wooden  beds  after  scalding 
where  possible  with  hot  water,  spray  the  crevices  of  floor,  back  of  picture 
frames  and  where  a  house  is  "alive"  with  the  pests  repaper  and  paint 
rooms.  Spirits  of  turpentine  will  kill  where  carbolic  acid  has  failed. 
After  each  spraying,  watch  for  the  bedbugs  as  those  which  are  not  destroyed 
will  hasten  to  escape  and  can  be  killed.  Remember  benzine  and  turpentine 
are  inflammable  and  poisonous.  No  lights  should  be  permitted  in  the 
rooms  during  or  immediately  following  the  use  of  these  drugs.  When 
articles  cannot  be  sprayed,  as  books,  etc.,  seal  up  the  room  and  burn  a 
sulphur  candle.  Place  sulphur  candle  in  a  tin  cup  and  place  cup  in  a 
tin  or  metal  pie  plate  containing  water. 

lice — The  body  louse  has  been  found  to  be  a  carrier  of  typhus  fever. 
It  carries  the  germ  in  its  body  after  biting  a  sufferer  from  the  disease 
and  by  biting  a  person  can  inject  the  germ  into  his  blood.  Lice  belong  to 
the  insect  family.  The  species  which  infest  human  beings  are  about  1-10 
of  an  inch  in  length  and  are  found  on  the  covered  regions  of  the  body  and 
clothing.  Lice  always  grow  from  the  eggs  laid  by  an  adult  louse  and 
never  originate  from  filth  or  other  matter.  They  hatch  out  within  a  week 
and  the  young  are  capable  of  reproduction  in  less  than  two  weeks.  A. 
single  adult  female  will  produce  5,000  lice  within  eight  weeks. 

The  annoyance  of  these  pests  biting  a  human  being  will  cause,  i£ 
sufiiciently  prolonged,  a  nervous  irritation,  and  a  condition  of  ill  health 
follows.  There  are  three  types  of  lice  which  infest  man.  The  Head  Lice 
(Pediculus  Capitis),  the  Body  Lice  (Pediculus  Vestimentorum)  and 
Crab  Lice  (Pedicuhis  Inguinalis). 

The  Head  Lice. — They  are  grayish  in  color  with  blackish  margins 
and  show  a  reddish  tinge  due  to  the  blood  they  have  sucked  from  their 
victim.  The  eggs  or  nits  are  seen  attached  to  the  hair  shafts  on  the  scalp 
at  some  distance  from  the  end  of  the  hair  and  are  tiny  white  or  grayish 
pear-shaped  bodies  seen  iipon  close  examination. 

Treatment. — It  is  necessary  to  remove  eggs  and  adults  at  the  same 
time,  so  wet  the  hair  thoroughly  with  crude  petroleum  (from  any  drug 
store)  keep  hair  wet  for  three  hours,  then  wash  whole  head  with  warm 
water  and  soap.  Eepeat  this  wash  once  a  day  for  three  successive  days. 
The  eggs  can  then  be  removed  by  combing  the  hair  with  a  fine  tooth 
comb  wet  with  vinegar.  Where  possible  the  treatment  can  be  made  more 
thoroTigh  and  permanent  if  the  hair  is  cut  short. 

Body  Lice. — The  Body  Lice  are  larger  than  the  head  lice  and  are 
commonly  found  ujion  the  body.     This  type  has  bands  across  the  back. 


140  PEEVENTION  OF  UISEASE. 

Crab  Lice — They  usually  develop  in  the  seams  of  clothing,  however, 
the  eggs  have  been  found  upon  the  hairs  on  the  body's  surface.  They  live  in 
concealed  portions  of  the  clothing  where  the  skin  is  most  conveniently 
reached,  where  the  various  bites  are  to  he  found  most  often,  as  around  the 
neck,  across  the  slioulders,  the  upper  part  of  the  back,  around  the  waist 
and  outer  side  of  the  thighs. 

Treatment. — All  clothing  worn  should  be  boiled  and  gone  over  with 
a  hot  iron  to  destroy  them.  A  hot  bath  should  be  taken  by  the  person 
annoyed  by  the  parasites.  Bathing  suits  should  be  carefully  boiled  as 
they  often  become  infested  with  the  eggs  and  body  lice  from  a  person 
who  may  have  worn  the  suit  and  had  them  upon  his  or  her  clothing  or 
person. 

The  Crab  lice — These  are  a  smaller  type  of  the  former  species, 
as  head  or  body  lice.  They  are  nearly  as  wide  as  long.  They  have  strong 
legs  spread  out  on  the  sides  of  the  body,  which  makes  them  appear  like 
crabs.  They  are  of  whitish  color,  slightly  shaded  on  the  shoulders  and  legs 
with  a  red  tinge.  Crab  lice  are  found  upon  the  hairy  regions  of  the 
body  other  than  the  scalp.  The  spread  of  these  pests  can  be  checked  by 
washing  all  toilet  seats  with  scalding  water,  and  boiling  towels  and  linen 
from  suspected  persons.  Laundries  should  be  especially  careful  as  to  the 
thorough  boiling  and  disinfection  of  all  clothing,  as  the  eggs  of  these 
parasites  can  be  conveyed  in  bed-clothing,  towels,  etc. 

Treatment. — Shave  the  hair  in  the  region  of  the  itching  and  wash 
twice  a  day  with  a  lotion  made  of 

Tincture   of   Larkspur y^   ounce 

Commercial  Ether    8  ounces 

The  Itch  Mite — This  parasite  which  afflicts  man  caiises  the  condition 
spoken  of  as  "Itch,"  "Seven  Years  Itch,"  "Army  Itch,"  "Jackson  Itch," 
etc.  It  has  an  oval  body  with  spine-like  projections.  The  female  is 
larger  than  the  male  and  measures  1-70  of  an  inch  in  length  by  1-50 
of  an  inch  in  width.  The  female  causes  the  development  and  pain  of  the 
afflicted  person.  She  burrows  into  the  superficial  skin,  forming  a  tortuous 
or  a  straight  dotted  line,  slightly  elevated  which  varies  from  1/8  to  1/2 
inch  in  length.  This  line  if  observed  closely  appears  dark  gray  or  blackish 
in  color  and  is  slightly  more  elevated  at  one  end.  Tlie  eggs  are  laid  in 
this  furrow  and  at  the  elevated  end  is  usually  found  the  female,  which 
has  perished,  as  a  rule.  It  takes  almost  13  to  20  days  for  the  eggs  to 
develop  into  adult  mites.     The  young  mites  feed  upon  the  tissues  of  the 


THE    PUBLIC    DEINKING    CUP.  14:1 

body  and  move  aboiit  causing  discomfort  until  they  I'each  the  surface 
of  the  skin  where  they  mate  and  females  start  a  fresh  burrow  and  deposit 
more  eggs. 

The  Itch  Mite  is  commonly  found  in  the  skin  between  the  fingers, 
hands,  folds  of  the  wrist,  arm  pits,  around  the  stomach  and  about  the 
neck.  It  is  not  known  as  a  carrier  of  disease,  but  can  be  dangerous  to 
health  by  causing  burrows  in  the  skin  and  abrasions  due  to  scratching 
which  afford  an  opening  for  germs  to  enter  the  system  of  the  bitten 
individual. 

The  Itch  Mite  can  bj  conveyed  from  one  pei-son  to  another  by  means 
of  towels,  clothing,  bathing  suits,  etc.,  carelessly  washed,  handled,  or 
worn  by  anyone  afflicted  with  the  pests. 

Treatment. — To  destroy  them,  have  all  bed  linen  and  clothing  used 
by  the  individual  infested,  thoroughly  boiled  or  baked.  Treat  the  region 
of  the  body  by  taking  a  bath,  washing  first  with  warm  water  and  castile 
soap,  using  a  brush  to  thoroughly  open  up  the  burrows  and  expose  the 
eggs  for  destruction.     After  this,  apply  an  ointment. 

Sublimed  sulphur one  drachm      (teaspoonful) 

Balsam  of  Peru one  drachm      (teaspoonful) 

Vaseline one  ounce      (2   tablespoonfuls) 

Hub  in  morning  and  evening  for  from  two  to  four  days  and  repeat  at 
end  of  a  week  if  any  itching  continues. 

THE  PUBLIC  DRINKING  CITP. 

The  drinking  cup  is  a  common  carrier  of  disease.  It  can  and  does 
spread  consumption,  syphilis  and  typhoid  fever.  Any  child  or  adult 
suffering  from  tonsilitis,  diphtheria,  scarlet  fever  or  other  communicable 
diseases  can  infect  another  by  using  a  public  tumbler  or  cup,  whether  at 
a  public  railroad  station,  school  house,  ball  park,  pump,  railroad  train, 
ferry  boat  or  steamship  of  any  kind,  etc. 

The  most  of  the  State  Boards  of  Health  have  had  laws  passed  in 
recent  years  to  abolish  the  public  drinking  cup  and  those  states  which 
have  not  done  so  are  neglecting  the  public  health  by  not  enforcing  this 
preventive  measure,  which  would  aid  in  checking  the  spread  of  disease. 

The  drinking  cup  should  be  replaced  by  a  sterile  paper  cup  which 
can  be  purchased  in  sealed  packages  or  containers  and  are  given  away 
free  of  charge  in  trains,  etc.,  and  can  be  purchased  for  one  penny  from 
the  slot  machines  in  stations.     They  are  destroyed  after  use  and  a  more 


142  PREVENTION   OF  DISEASE. 

refresliing  and  sanitary  drink  is  obtained  and  the  danger  of  contracting 
disease  eliminated.     The  Public  Drinking  Cup  Must  Go. 

THE  PUBLIC  TOWEL. 

The  toTvels  in  toilets,  bedrooms  of  hotels  and  boarding  houses  can 
spread  disease  unless  they  are  thoroughly  boiled  and  laundered  after  use, 
Most  hotels,  railroad  stations,  Pullman  cars,  etc.,  have  done  away  "with 
the  ]iublic  towels  in  toilets  and. use  a  heavy  tissue  paper,  either  as  a  single 
towel  or  in  rolls  and  torn  off  as  needed,  which  is  not  expensive  and  is 
thrown  away  after  use. 

In  Pennsylvania  the  State  Board  of  Health  has  urged  saloonkeepers, 
etc.,  to  do  away  with  the  forks  and  spoons  which  are  placed  in  a  tumbler 
of  water  and  are  used  by  all  comers  at  the  free  lunch  counter  and  then 
replaced  in  the  tumbler  of  dirty  water  for  the  next  victim  to  use. 

Disease  can  be  controlled  better  when  our  proprietors  of  saloons, 
restaurants,  hotels,  soda  fountains,  etc.,  employ  only  healthy  emijloyees, 
free  from  disease  and  take  pains  to  boil  or  scald  every  public  glass  and 
chinaware  used  by  not  only  dirty,  but  disease-spreading  persons.  The 
barroom  towel  which  hangs  in  front  of  the  bar  in  the  cheaper  saloons 
for  customers  to  wipe  their  mouth'  and  hands  upon,  must  not  be  permitted. 

VENEREAL  DISEASES. 

Syphilis,  gonorrhoea  and  a  host  of  diseases  which  follow  in  their 
train,  come  within  the  scope  of  Preventive  Medicine.  They  are  not  spread 
by  water,  air,  food,  or  insects  as  are  so  many  diseases,  but  develop  only 
from  contact  with  a  sufferer  (usually  by  co-habitation,  but  possible  by 
non-sexual  contact),  or  by  the  germs  from  a  sufferer  being  imparted  to 
another  by  towels,  clothing  or  other  articles.  They  may  be  communicated 
to  an  innocent  wife  by  a  diseased  husband  and  vice  versa,  and  many 
serious  diseases  and  infirmities  depending  on  these  diseases  may  be  trans- 
mitted to  the  children  of  the  diseased,  as  instance  the  disease  of  Opthal- 
mia  or  Blindness  in  Children,  which  occurs  at  or  shortly  following  birth, 
and  which  is  usually  attributable  to  one  or  both  of  the  parents  suffering 
from  gonorrhoea,  although  it  may  arise  from  other  causes  (see  Index 
for  article  on  Opthalmia,  its  cause,  treatment  and  prevention). 

Syphilis  and  gonorrhoea  are  so  largely  dependent  on  immoral  inter- 
course that  their  prevention  is  largely  a  matter  of  moral  uplifting  of  the 


VEWEEEAL   DISEASES.  143' 

people.  But,  pending  this  morai  uplifting,  mueli  is  possible  by  the  State 
and  municipal  governments  jilacing  these  diseases  on  the  list  of  contagious 
diseases  which  must  be  reported  to  the  authorities,  as  is  now  required  in 
respect  of  small-pox,  scarlet  fever  and  other  diseases  which  are  neither 
so  loathsome  nor  have  such  far-reaching  results  for  ill  to  mankind. 

All  parents  should  carefully  read  the  articles  on  Syphilis,  Gonorrhoea 
and  Opthalmia,  to  bo  found  elsewhere  in  this  work  (see  Index),  and  then 
they  should  carefully  guard  their  children  and  at  proper  age  thoroughly 
instruct  them  in  the  fearful  ravages  of  venereal  disease.  There  is  too 
much  false  modesty  in  these  matters  on  the  part  of  parents.  The  general 
discussion  of  sexual  matters  in  novels,  in  sensational  books  on  eugenics 
and  in  ordinary  conversation  is  to  be  condemned,  but  it  is  the  duty  of 
every  mother  to  her  daughter  and  of  every  father  to  his  son,  to  not  only 
keep  constant  guard  over  them  in  these  matters,  but,  at  the  beginning  of 
puberty,  to  instil  into  their  minds  the  real  truths  that  they  may  become 
imbued  with  the  horrors  of  venereal  disease,  yet  realize  the  nobility  of 
true  sexual  life.  Professors  and  teachers  in  resident  schools  and  colleges 
where  youth  is  congregated  should  also  have  regard  to  this  vital  subjeot 
and  take  means  to  properly  impart  useful  knowledge,  and  not  only  adopt 
every  possible  precaution  to  prevent  students  from  meeting  lewd  persons, 
but  by  periodical  medical  examination  discover  if  any  venereal  disease 
is  existent,  and  If  found  in  any  individual  then  suspend  such  student 
imtil  the  disease  be  eradicated  beyond  the  possibility  of  contagion. 

Syphilis  Is  a  more  horrible  disease  than  small-pox  and  may  bo  easily 
communicated  to  the  innocent  by  a  common  towel,  by  a  brother  kissing 
his  sister  or  a  son  his  mother,  and  in  many  other  ways,  and  yet  the 
Byphilltically  diseased  may  go  where  they  please  and  little  or  no  pre- 
/autions  are  taken  as  to  the  spreading  of  the  disease.  It  is  estimated  that 
i'n  New  York  City  alone  250,000  people  are  suffering  from  this  loath- 
some disease,  either  inherited  or  acquired,  and  when  it  Is  borne  in  mind 
that  large  numbers  of  these  have  innocently  acquired  It  and  are  now  in 
turn  transmitting  it  to  others,  the  enormity  of  the  evil  and  the  imperative 
need  of  preventive  measures,  will  be  realized. 


INDEX  TO  PART  II  OF  BOOK  III 

Preventive  Medicine 


Water  In  Its  Hygenic  Relations 

Part  II  of  Book  III  treats  of  pure  and  impure 
water  and  its  various  effects  upon    the  human  body, 
both  as  respects  internal  and  external  uses. 
SUBJECTS  OF  THE  TEXT 


Air   in   water 148 

Alkaline  Waters,  Diseases  Caused  by,  151 

Alluvial   Waters    163 

Arsenic  in  Water 156 

Artesian- Well    Waters    165 

Bathing  Beneficial  for  Rheumatism. .  .174 

Baths,   Cold    169 

Baths,  Hot  176 

Baths,  Hygienic  Use  of  Cold  Baths...  169 
Baths,  Hygienic  Use  of  Warm  Baths.  174 

Baths  for  Old  Age 173 

Baths,    Temperature   of 169 

Baths,  Cold  Varieties  of 172 

Baths,  Warm   174 

Bright's  Disease  Caused  by  Water...  153 

Chalky  Waters    164 

Cholera  Due  to  Impure  Water 156 

Cold  Baths    1C9 

Detection  of  Contaminated  Water....  165 

Diarrhoea  Due  to  Impure  Water 159 

Distilled  Water    148 

Drinking   Water,    Sources    of 149 

Dysentery  Due  to  Impure  Water 159 

Farmhouses,    Danger    from    Polluted 

Water    159 

Fever  Germs  in  Ice 161 

Flesh  Brush  Exercise 174 

Goitre,  Water  as  a  Cause  of 152 

Gfaveyard  Waters    163 

Green   Waters    166 

Hot   Baths    176 

Hydropathy    - .  - 1 73 

Hygiene  of  Cold   Baths 169 


Hygiene  of  Sea  Bathing 177 

Hygiene  of  Warm   Baths 174 

Ice  as  Cause  of  Disease 160 

Ice   from  Contaminated   Ponds 161 

Ice,    Fever    Germs    in 161 

Impure  Water  Cause  of  Diarrhoea  and 

Dysentery    1 59 

Impure  Water  Cause  of  Worms 163 

Impurity   of    Water 152 

Infectious      Diseases      from      Impure 

Water    156 

Iron    in    Water 156 

Lead  Poison  in  Water — • 

Apply  Test   for 155 

Causes  of  154 

Detection    of    154 

Diseases  from  155 

Frequency  of    153 

In    Rural    Districts 153 

Obviation    of    155 

Palsy  from   154 

Virulence  of   154 

Limestone  Waters 164 

Marsh  Waters    163 

Mineral   Springs    130 

Mountain  Fever  Due  to  Snow  Water,  162 

Need   of  Water 147 

Precautions  for  Travelers 169 

Privy,  Well  and  Stables,  Proximity  of,  159 
Pure  Water  a   Sanitary   Necessity. ..  .163 

Purifying  Ingredients  in  Water 151 

Rain  Water  730 

Rain  Water,  Purity  of;  Impurities  in,  149 


10 


145 


146 


INDEX    TO    PAET    II    OF   BOOK    III. 


Rheumatism,  Bathing  Beneficial  for...  1^4 

River  Water  150 

Rock  Water    163 

Rules  for  Pure  Water 167 

Saline  Impurities  of  Water 151 

Sand  and  Gravel  Waters 163 

Sanitarj-  Necessity  of  Pure  Water...  163 

Sca-Bathing,   Hygiene  of 177 

Seashore- Well  Waters 165 

Sea   Water    14S 

Sewer-Gas  Poison  Through  Water. . .  .160 

Snowr  Water,  Dangers  of 162 

Soil   Waters    164 

Spring  and  Well  Waters 150 

Stagnant  Water  150 

Surface  Waters  164 

Temperature  of  Warm  Baths 174 

Tests  of  Water 166 

Ammonia  Test  168 

Chemical     167 

Microscopic   166 

Necessity  of 169 

Nesler  Test  168 

Soap  Water   Test 168 

Taste  as  Test 166 

Taste  Due  to 167 

Taste  Fails  as  Test 167 

Typhoid  from  Polluted  Water 157 

Typhoid  from  Well  Water 158 

"Warm   Baths    174 

Warm  Baths,  Temperature  of 174 

AVater,  Air  and  Gases  in 148 

Water,   Arsenic   in 156 

Waters,  Alluvial  164 

"Waters,  from  Artesian  Wells 165 

Water  as  a  Cause  of  Bright's  Disease,  153 

Water  as  a  Cause  of  Goitre 152 

Water  from  Chalk  Formations 164 

Water  from  Clay  Formations 164 

Water,  Contaminated, — Detection  of..  165 
Water   Cure    173 


Water,    Diseases    from 151 

Water,  Distilled  148 

Water  for  Drinking,  Sources  of 149 

Water,  Effect  of  Metallic  Impurities,  153 

Water    from   Graveyards 165 

Waters,  Green 166 

Water,  How  Poisoned  by  Lead 154 

Water,  Human  Need  of 147 

Water  Impurity,   Its  Deadly  Effects,   158 

Water,  In  What  Contained 147 

Water,  Infectious  Diseases  Caused  by 

Impure  Water   156 

Water,  Iron  in 156 

Water,   Lead   Poison   in 153 

Water  from  Limestone 164 

Waters,    ^Marshy    165 

Water   as    a    Medium    for    Sewer-Gas 

Poison  160 

Water,  Organic  Impurities  in 152 

Water  Precautions  for  Travelers 169 

Water,    Purity    of    and    Impurities    in 

Rain   Water    149 

Water,   Quantity  Needed 150 

Water  from  Rocks 163 

Water,  Rules  for  Pure  Water 167 

Water  from  Sand  and  Gravel 163 

Water  of  the  Sea 148 

Waters  from  Seashore  Wells 165 

Water  from  Snow,  Dangers  in 162 

Waters,  Soil   164 

Waters,   Surface    164 

W'ater,  Tests  of. — See  Tests  of  Wa- 
ter    150 

Water,  Varieties  of 150 

Waters,  Yellow   166 

Well,  Privy  and  Stables,  Pro.ximity  of,  159 

Well  Waters  Ijo 

Well  Water  Cause  of  Typhoid 158 

Worms  from  Impure  Water 163 

Yellow   Waters    166 


PREVENTIVE  MEDICINE 

PAET  II. 
WATER  IN  ITS  HYGIENIC  RELATIONS 


THE  USES  OF  WATER. 

Adaptation  of  Water  to  Human  Needs — Few  people  who  eujoy  the 
benefits  of  water  thiiik  what  a  wonderful  and  unanswerable  ai'gamient 
is  aftbrded  by  them  in  favor  of  the  goodness  of  an  all-wise  Creator  to  his 
creature,  man.  Of  all  the  fluids  with  which  we  are  acquainted  water  is 
by  far  the  Ix^st  adapted  to  the  almost  infinite  variety  of  human  wants,  and 
it  is  the  one  of  all  others  most  abundant  in  nature,  constituting  as  it  does 
about  three-fifths  of  the  surface  of  our  globe,  and  nearly  seven-tenths  of 
the  bodies  of  man  and  of  most  animals.  If  the  common  fluid  upon  which 
we  had  to  depend  were  quicksilver,  or  oil,  its  boiling-point  would  be  so 
high  that  articles  of  food  which  we  attempted  to  cook  in  it  would  be 
seriously  injured  in  the  effort  to  prepare  them  by  its  aid;  and,  on  the 
other  hand,  nearly  all  the  advantages  of  ice  would  fail  us,  in  consequence 
of  the  exceedingly  low  temperature  at  which  these  substances  remain  fluid. 

Water  in  All  Substances — Water  was  considered  by  the  ancient  phil- 
osophers as  one  of  the  four  elemeiits  out  of  which  all  visible  objects  were 
constructed ;  and,  in  reality,  it  enters  to  a  greater  or  less  extent  into  the 
coniposition  of  nearly  all  natural  substances.  Thus,  for  example,  some 
vegetables,  like  cabbage  or  celery,  contain  as  much  as  ninety-five  per  cent, 
of  water;  and,  on  the  other  hand,  close-gTained  marble  may  contain  a8 
much  as  four  per  cent,  of  water,  or  almost  a  quart  to  the  cubic  yard.  On 
account  of  its  remarkable  solvent  powers,  which  enable  it  to  take  up  a 
smaller  or  larger  quantity  of  nearly  every  substance  with  which  it  comes 
in  contact,  water  is  never  found  pure  in  a  natural  state;  and,  indeed, 
absolutely  pure  water  for  chemical  purposes  can  only  be  obtained  by 
repeated  careful  distillations. 

(147) 


148  WATEE  IN   ITS   HYGIENIC    RELATIONS. 

Air  and  Gases  in  "Water. — A  considerable  amount  of  air  generally 
exists  in  water,  and  is  taken  up  by  the  gills  of  fishes,  assisting  them  to 
accomplish  the  proper  aeration,  or  rather  oxygenation,  of  their  blood. 
The  air  usually  mingled  with  water  may  be  expelled  by  boiling,  but  is 
absorbed  again  if  the  boiled  water  is  agitated  with  access  of  the  atmos- 
phere. 

Boiled  Water. — The  insipid  taste  of  water  which  has  been  Iwiled  is 
due  to  the  absence  of  air.  Many  gases  besides  air  may  be  artificially  or 
naturally  mingled  with  water,  and  some,  like  ammonia  or  nitric  acid,  are 
freely  soluble  in  it.  In  sea-water,  the  presence  of  common  salt,  with  small 
quantities  of  sulphate  of  soda  or  Glauber's  salt,  and,  of  the  compound  of 
magnesia  and  chlorine,  called  chloride  of  magnesium,  render  it  entirely 
unfit  for  drinking,  as  many  a  hapless  shipwrecked  sailor  has  found  to  his 
cost. 

Distilled  "Water — At  the  present  day,  most  sea-going  vessels  are 
provided  with  apparatus  for  distilling  the  water  of  the  ocean,  and  so  pro- 
ducing a  pure  and  wholesome  but  insipid  water,  which  can  be  rendered, 
however,  more  palatable  by  agitation  with  plenty  of  fresh  air.  Hence,  the 
horrible  agony  of  death  by  thirst  among  sailors  is  now  much  less  frequent 
than  formerly,  although  mariners  in  open  boats,  or  cast  upon  small  un- 
inhabited islands,  still  sometimes  scan  with  anxious  eyes  the  briny  waste 
around  them,  beholding — 

"Water,  water  everywhere,  but  not  a  drop  to  drink." 

Sea-Water. — Sea-water  varies  considerably  in  composition,  being,  of 
course,  more  concentrated,  as  a  rule,  in  the  tropical  regions,  where  evap- 
oration is  most  active,  such,  for  example,  as  in  the  ilediterranean  Sea  and 
the  Atlantic  Ocean  near  the  equator.  According  to  analysis,  the  water 
in  the  English  Channel  contains  in  1000  parts — 

Chloride  of  Sodium 28.05 

Chloride   of  Magnesium 3.66 

Sulphate   of   Mag-nesia 2.29 

Sulphate  of   Lime 1.40 

Other    Saline   Materials 76 

Total   Solid   Matter 36.16 

Besides  these,  and  perhaps  contributing  largely  to  the  healthful 
qualities  of  sea-water,  there  exist  in  the  ocean  small  quantities  of  iodine 


SOUECES  OF  DRINKING  WATER.  149 

and  bromide,  and  extremely  minute  amounts  of  some  o£  the  common 
metals.  It  has  been  found  that,  by  dissolving  a  little  common  salt  and 
carbonate  of  soda,  lime  and  magnesia  in  distilled  sea-water,  its  taste  is 
rendered  much  more  agreeable ;  and  this  jjlan,  it  is  said,  is  adopted  in  the 
Russian  navy. 

Purity  of  Rain-Water. — The  water,  which  rises  in  vapor  into  the 
atmosphere  from  all  the  oceans,  seas,  lakes  and  rivers  of  the  globe  is 
condensed  after  a  longer  or  shorter  time,  and  falls  to  the  earth  again  as 
rain.  Rain-water,  being  in  reality  a  distilled  fluid,  is  the  nearest  approach 
to  a  pure  water  which  we  find  in  nature,  and  when  caught  in  clean  vessels 
placed  upon  elevated  objects  is  almost  free  from  contamination. 

Impurities  in  Eain-Water — It  contains,  however,  small  quantities  of 
organic  matter,  nitric  acid  and  ammonia,  all  of  which  are  washed  oiit  of 
the  air  through  which  it  descends  as  rain.  The  source  of  the  nitric  acid 
is  believed  to  be  the  nitrogen  of  the  atmosphere,  which  combines  with 
oxygen  under  the  influence  of  the  electric  spark  during  thunder-storms. 
Nitric  acid  in  rain-water  exists  in  such  insignificant  amount  as  to  be 
entirely  unimportant  in  itself;  but  it  adds  very  seriously  to  the  danger  of 
impregnation  with  lead  from  lead  pipes,  roofs  and  cisterns  by  rapidly 
dissolving  that  metal  and  forming  the  very  soluble  and  highly  poisonous 
salt,  nitrate  of  lead. 

SOURCES  OF  DRINKING  WATER. 

Evaporation — Our  supplies  of  drinking  water  are,  of  course,  derived 
originally  entirely  from  the  rainfall.  We  need  not  consider  now  how  the 
water  found  its  way  into  the  air.  Without  entering  into  the  details  of  the 
process  of  evaporation,  all  that  the  present  object  requires  is,  that  we 
clearly  recognize  the  fact  that  spring,  fountain,  river  and  lake  are  all 
alike  fed  from  the  clouds  which  float  over  our  heads  and  send  their  rain 
upon  the  just  and  upon  the  unjust.  Hence,  then,  man  is  wholly  dependent 
for  his  supply  of  this  vital  element  upon  the  rain  which  comes  down  from 
heaven.  He  may  dwell  upon  the  most  arid  plains,  but  he  drinks  from 
the  stream  which  flows  beside  or  underneath  his  feet — which  stream  is 
itself  fed  by  floods  that  fell  perhaps  a  thousand  miles  away — and  wliat- 
ever  niysterj'  attaches  to  subterranean  waters,  we  may  be  sure  that,  by  a 
long  enough  circuit,  we  can  trace  every  drop  back  to  the  clouds. 


150  WATBE  IN  ITS   IITOIENIC  EELATIONS. 

VARIETIES  OF  WATER. 

Rain-Water. — In  classifying  waters,  we  have  first  to  consider  them 
as  regards  their  sources,  Kain-water,  as  already  mentioned,  is  sweet  and 
soft,  and  when  filtered  is  perfectly  adapted  to  all  the  purposes  of  life ;  the 
one  ditficulty  about  its  use  being  the  impossibility  of  collecting  it  pure 
and  preserving  it  without  contamination  for  the  long  periods  of  time 
and  in  the  large  quantities  which  would  often  be  necessary. 

Spring,  and  Well- Waters. — Spring-  and  well-waters  are  almost  always 
more  or  less  impregnated  with  the  soluble  ingredients  of  the  earth  and 
rocks  through  which  they  pass,  and  are  therefore  sometimes  very  unsuit- 
able for  the  ordinary  wants  of  life.  As  a  general  rule,  they  are  colder  than 
other  waters,  although  hot  springs  are  found  in  various  parts  of  the  world, 
some  with  a  temperature  as  high  as  the  boiling  point. 

Mineral  Springs. — ^]\Iineral  sj^rings,  notwithstanding  they  are  much 
■used  for  drinking,  are  properly  medicinal  agents.  They  comprise  all  those 
waters  which  contain  suiRcient  quantities  of  dissolved  matters,  such,  for 
example,  as  iron  or  sulphur,  as  to  produce  thereby  a  positive  effect  upon 
the  systems  of  persons  partaking  of  them.  The  mineral  springs  of  this 
country  are  frequently  valuable  remedial  agents'  in  some  chronic  diseases. 

River-Water — Eiver-water  Is,  to  a  certain  extent,  similar  to  spring- 
water,  but  is  much  more  apt  tc  be  contaminated  with  sand  and  clay, 
organic  material  from  decomposing  vegetable  or  animal  remains,  the 
refuse  of  manufactories,  and  especially  with  the  sewage  of  cities  and 
to%vns,  to  which  it  is  probable  immense  amounts  of  sickness  and  death  are 
annually  due  in  all  civilized  countries.  Unfortunately,  river-water  is  that 
which  is  chiefly  supplied  to  towns  and  cities,  and  therefore  finds  its  way 
into  the  systems  of  vast  numbers  of  our  fellow-beings. 

Stagnant  Water. — Stagnant  water  is,  from  the  large  quantity  of 
organic  matter  in  a  decomposing  state  which  it  holds  in  suspension  or 
solution,  exceedingly  unfitted  for  drinking  and  culinary  purposes,  no 
matter  how  transparent  it  may  appear ;  and  it  should,  in  consequence,  bo 
carefully  avoided  whenever  running  water  can  possibly  be  procured. 
Pond-water,  canal-water,  ditch-water  and  marsh-water  all  come  under  this 
category,  and  should  be  scrupulously  shunned,  under  penalty  of  suffering 
from  fever  and  ague,  dysentery,  typhoid  fever,  and  many  other  dangerous 
maladies. 

Quantity  of  Water  Needed — The  quantity  of  water  needed  by  man 
and  animals  must  therefore  be  very  carefully  calculated,     Kepeated  ex- 


VAEIOUS   -WATERS.  151 

periments  upon  a  very  extended  scale  in  England  have  shown  that  a 
healthy  man  requires  daily  as  drink  from  two  to  four  pints  of  water,  this 
amount  being  in  addition  to  that  which  is  swallowed  as  moisture  in  food. 
The  amount  required  for  cooking  is  estimated  at  from  half  a  gallon  to  a 
gallon  or  more.  To  this  quantity,  Dr.  Parkes  considers  should  be  added 
for  daily  ablution,  including  a  sponge  bath,  five  gallons;  daily  share  of 
kitchen  and  other  utensils,  and  house  washing,  three  gallons;  and  share 
of  clothes  washing,  another  three  gallons;  making  up  a  total  of  a  little 
over  twelve  gallons  for  each  individual  daily.  In  the  poorer  districts  of 
the  city  of  London,  the  amoimt  used  is  stated  to  be  only  about  five  gallons 
daily.  A  shower-bath  will  require  about  four  gallons  extra,  and  a  plunge- 
bath  from  forty  to  sixty  gallons.  Where  water-closets  are  used  an  addi- 
tional quantity  of  from  four  to  six  gallons  daily  for  each  person  must  be 
provided. 

DISEASES  FROM  MINERAL  IMPURITIES  IN  WATER. 

Purifying  Ingredients. — Since  all  rivers,  spring-  and  well-waters  con- 
tain a  certain  amount  of  dissolved  matters,  taken  up  from  the  soil  through 
and  over  which  they  pass,  it  becomes  a  very  important  consideration  to 
determine  what  these  ingredients  are  in  any  particular  sample  of  water, 
and  also  the  kind  and  degree  of  such  impurity  which  will  not  prove 
injurious  to  health.  Dr.  Letheby,  from  investigations  made  in  sixty-five 
English  and  Scotch  towns,  arrived  at  the  conclusion  that  from  five  to 
twenty  grains  to  the  gallon  of  the  compounds  of  lime  and  magnesia  arc 
necessary  to  render  drinking  water  in  the  highest  degree  wholesome. 

Saline  Impurity. — But  any  quantity  of  saline  impurity  exceeding 
thirty-five  grains  to  the  gallon  renders  a  water  unfitted  for  the  freest 
domestic  use.  Such  water  would  be  popularly  designated  as  a  very  "hard" 
water,  but  a  good  deal  of  indifference  is  caused  by  the  nature  of  the  hard- 
ness, that  due  to  sulphate  of  lime,  and  called  the  permanent  hardness  be- 
cause it  is  not  removable  by  boiling,  being  decidedly  most  prejudicial  to 
health. 

Diseases  Caused  by  Alkaline  Waters. — The  symptoms  referable  to  an 
excess  of  alkalinity,  arising  from  the  presence  of  these  earthy  salts  in  a 
drinking  water,  are  mainly  those  of  a  dyspeptic  nature.  At  first  the 
cmplopnent  of  hard  water  by  persons  who  are  unaccustomed  to  it  pro- 
duces diarrhoea,  which  is  occasionally  serious  or  even   dangerous  in  its 


152  WATER   IN   ITS   HYGIENIC   RELATIONS. 

character.  But  the  long-continued  use  of  such  a  drinking  fluid  is  thought 
to  cause  habitual  constipation,  with  the  heavy  train  of  evils,  including 
])ilcs  and  liver  complaint,  which  depend  upon  it.  Calculus,  or  stone  in 
the  kidney  or  in  the  bladder,  which  gives  rise  sometimes  to  the  most 
horrible  agony  human  beings  are  ever  called  upon  to  endure,  is  believed 
to  be  due,  in  many  instances,  to  an  excess  of  lime  and  magnesian  salts  in 
the  drinking  water. 

Cause  of  Goitre — The  swelling  of  tho  thyroid  gland  in  the  neck, 
producing  the  repulsive  deformity  of  Goitre,  or  Derbyshire  neck,  seems 
to  be  intimately  connected  with  mineral  impurities  in  water.  In  Notting- 
ham, England,  where  this  disease  is  not  unfrequently  met  with,  the  com- 
mon people  attribute  it  to  the  hardness  of  the  water,  and  in  other  parts 
of  Great  Britain  it  is  found  to  prevail  only,  or  at  least  especially,  in  those 
districts  where  the  magnesian  limestone  formation  abounds. 

Goitre  in  Switzerland.— Dr.  Coindet,  of  Geneva,  Switzerland,  asserts 
that  Goitre  is  speedily  produced  in  persons  who  drink  the  hard  pump- 
water  in  the  lower  part  of  that  town,  whilst  in  other  parts  of  Switzerland 
the  use  of  spring-water  has  been  followed  by  the  development  or  augmen- 
tation of  Goitre  in  a  very  few  days.  In  India  also  it  has  been  shown 
conclusively  to  prevail,  to  any  marked  extent,  only  where  the  magnesian 
limestone  rocks  underlie  the  soil ;  but  whether  it  is  the  lime  and  magnesian 
salts,  or  whether,  as  has  been  suggested,  it  is  the  presence  of  sulphide  of 
iron  in  the  bed-rock  formation,  which  is  the  direct  cause  of  the  develop- 
ment of  Goitre,  has  not  yet  been  positively  determined.  It  appears  cer- 
tain, however,  that  Goitre  is  originated  by  some  water  impurity,  and  that 
this  contamination  is  of  an  inorganic  and  not  of  an  animal  or  vegetable 
nature. 

Organic  Impurities  in  Water. — A  small  quantity  of  organic  matter  of 
vegetable  origin,  that  is  to  say,  an  amount  not  exceeding  three  grains  to 
the  gallon,  is  not  generally  found  to  be  injurious,  but  even  very  minute 
quantities  of  organic  material  of  animal  origin,  especially  if  this'  material 
is  composed  of  the  waste  matters,  such  as  urine  or  excrement,  from  man 
or  animals,  is  the  great  cause  of  unwholesomeness  of  water.  Probably 
one-fourth  of  the  sickness  and  death  in  civilized  communities  arises  di- 
rectly or  indirectly  from  this  one  cause,  and,  unfortunately,  even  when  we 
are  fully  forewarned  of  this  imminent  danger  to  health,  it  is  exceedingly 
dilRcult,  in  most  thickly  populated  places,  to  secure  a  source  of  water 
supply  with  which  sewage  has  not  been  mingled. 


DISEASES  FROM  IMPURE  WATERS.  153 

Effect  of  Metallic  Impurities. — The  effects  of  minute  traces  of  metallic 
substances  in  drinking  water  have  not  yet  been  ascertained  with  sufficient 
accuracy,  but  it  is  quite  possible  tliat  the  entire  sanitary  condition  of  a 
district  may  depend  in  some  measure  upon  impurities  of  this  description. 
Mr.  Wanklyn  suggests  that  the  well-kno\\Ti  salutary  effect  of  what  is 
called  change  of  air  may  bo,  in  reality,  partly  due  to  the  escape  from  some 
extremely  small  metallic  impiirity  in  the  water  of  the  section  of  country 
from  which  removal  takes  place. 

Cause  for  Bright's  Disease — It  has  long  seemed  probable  that  the 
increasing  prevalence  of  that  terribly  fatal  malady,  "Bright's  disease," 
especially  in  cities  and  large  towns,  may  bs  due  to  the  poisonous  effects  of 
exceeding  minute  quantities  of  lead,  dissolved  from  the  lead  pipes  so 
generally  employed  as  service-conduits,  notwithstanding  the  protective 
coating  which  usually  forms  so  promptly  upon  them. 

lead  Poison  in  Water — These  are  probably  very  common  throughout 
our  whole  country,  and,  contrary  to  what  at  first  sight  might  be  imagined, 
it  is  likely  that  lead  much  more  frequently  and  seriously  affects  the  health 
of  people  inhabiting  small  villages  and  country  houses,  than  that  of  resi- 
dents in  cities,  notwithstanding  the  latter  constantly  use  water  which  is 
brought  into  their  houses  through  long  lines  of  lead  service-pipes.  The 
explanation  of  this  seeming  paradox  is  that  river-water,  which  is  that 
usually  supplied  to  citizens,  contains  in  almost  all  cases  a  small  amount  of 
the  sulphate  of  lime,  sulphate  of  magnesia,  or  some  other  compound  of 
sulphuric  acid,  which,  when  brought  in  contact  with  the  lead  pipes,  is 
decomposed,  and  the  resulting  sulphate  of  lead  which  is  formed  has  the 
happy  faculty  of  clinging  to  the  inside  of  the  pipes  where  it  is  produced, 
and  thus  constituting  an  insoluble  lining,  which  not  only  protects  the  tulw 
from  fiirther  corrosion,  but  also,  what- is  of  far  greater  importance  from  a 
sanitary  point  of  view,  prevents  any  further  contamination  of  the  drinking 
water  which  flows  through  the  conduit. 

Lead  Poison  in  Rural  Districts. — Tn  rural  districts,  on  the  other  hand, 
wherever  rain-water  is  used  for  drinking  purposes,  it  is  exceedingly  liable 
to  be  contaminated  with  lead  from  load-lined  cisterns,  lead  service-  or 
collection-pipes,  lead  roofs,  or  from  the  solder  of  tin  roofs.  As  a  rule, 
the  purer  the  rain-water,  the  greater  is  its  action  on  lead  with  which  it 
stands  in  contact;  hence,  therefore,  the  presence  of  a  minute  quantity  of 
some  salt  of  sulphuric  acid  in  water  is  of  very  great  importance,  and 
serves  as  an  invaluable  protection  against  lead-poisoning  to  the  human 
beings  and  animals  who  may  employ  it  for  drinking  purposes. 


154  WATER    IN    ITS    HYGIENIC    RELATIONS.  i 

How  Lead  Poisons  Water.— 'Wlicn  piu'e  water  recently  boiled  is  placed 
in,  or  run  over,  l»';id,  no  action  takes  place;  but  if  the  water,  after  being 
boiled,  is  exposed  for  a  short  time  to  tlie  air,  from  wiiich  it  absorbs  oxygen 
and  carbonic  acid,  and  is  then  brought  in  contact  with  lead,  we  soon  find 
that  a  whitish  film,  which  on  chemical  examination  is  found  to  be  com- 
posed of  the  carbonate  of  lead,  is  formed  upon  the  metallic  surface.  This 
whitish  film,  which  easily  separates  from  the  lead  on  which  it  appears, 
and  becomes  mechanically  mixed  with  water,  is  very  poisonous.  Since, 
as  already  mentioned,  rain-water  contains  usually  some  nitric  acid,  in 
addition  to  the  oxygen  and  carbonic  acid  which  it  absorbs  from  the  air, 
and  this  nitric  acid  combines  with  lead  to  form  a  very  soluble  and  poison- 
ous nitrate  of  lead,  it  is  much  more  dangerous  than  even  pure  aerated 
.vater,  after  standing  for  a  short  time  in  contact  with  a  leaden  surface. 
Rain-water  intended  for  driidcing  or  cooking  pui'poses  ought,  therefore, 
never  to  be  collected  from  lead  or  tin  roofs,  transmitted  through  lead 
pipes,  nor  under  any  circumstances  stored  in  lead-lined  cisterns  of  any 
kind. 

Virulence  of  Lead  Poison — In  the  celebrated  case  of  the  accidental 
poisoning  of  the  ex-royal  family  of  France,  at  Claremont,  by  lead  which 
was  taken  up  in  the  drinking  water,  the  amount  was  found  not  to  exceed 
one  grain  of  metal  to  the  gallon  of  water.  From  cases  which  have 
since  been  obsei'\'ed,  it  would  appear  that  the  habitual  use  of  water  con- 
taining one-tenth  or  even  one-twentieth  of  a  grain  per  gallon,  is  some- 
times attended  with  danger.  In  his  investigation  into  the  cause  of  that 
curious  disease,  as  it  was  formerly  considered,  the  Devonshire  colic.  Sir 
George  Baker,  Avho  discovered  that  it  was  only  a  form  of  lead-poisoning 
due  to  the  drinking  of  cider  fermented  in  lead-lined  vats  and  troughs, 
found  that  eighteen  bottles  of  cider  he  examined  contained  four  and  a 
half  gi'ains  of  lead,  or  a  quarter  of  a  grain  to  each  bottle. 

Lead  Palsy — Under  some  special  circumstances,  not  at  present  well 
imderstood,  extremely  minute  amounts  of  lead  in  water  may  prove  in- 
jurious. Thus,  for  example,  Dr.  ^Vjigus  Smith  speaks  of  cases  in  which 
lead-paralysis,  or  palsy,  was  apparently  produced  by  water  containing 
only  one  one-hundredth  of  a  grain  of  lead  to  the  gallon. 

Detection  of  Lead  in  Water — The  method  of  detecting  the  probable 
presence  of  lead  in  a  sample  of  drinking  water  is  so  simple  that  every 
reader  is  advised  to  take  the  first  opportunity  of  examining  their  own 
water-supplies,  and  so  making  sure  that  they  or  their  families  are  not 
liable  to  the  insidious  dangers  of  lead-poisoning.  In  order  to  determine 
whether  a  water  is  contaminated  with  lead,  all  one  has  to  do  is  to  drop 


LEAD  POISON   IN   WATER.  155 

two  or  three  drops  of  the  solution  of  sulphide  of  ammonium  into  the 
suspected  fluid,  contained  in  a  white  bowl  or  large  cup,  and  observe 
whether  a  bro^vnish  or  yellowish  coloration  is  produced.  If  the  liquid 
•  remains  perfectly  clear  and  colorless  you  may  be  sure  that  it  either  con- 
tains no  lead,"  or  that  such  a  metallic  impurity  is  present  in  a  quantity  of 
less  than  one-tenth  of  a  grain  to  the  gallon,  an  amount  which  is  not  gen- 
erally injurious  to  health.  If,  however,  a  slight  brownish  tint  is  produced 
in  the  water  which  is  being  tested,  it  must  not  be  too  hastily  condemned 
as  poisoned,  since  either  copper  or  iron  might  give  rise  to  the  same 
coloration  with  the  reagent.  Such  a  suspicious  water  ought,  however,  to 
be  2:)romptly  analyzed  by  some  good  analytical  chemist  before  being  em- 
ployed for  either  cooking  or  di'iiiking  purposes  any  further. 

Applying  the  Test  for  Lead — The  sulphide  of  ammonium  may  be 
purchased  at  a  sma^l  cost,  say  for  twenty-five  cents  an  ounce,  of  most 
dealers  in  chemicals ;  and,  as  its  odor  is  extremely  disagreeable,  it  should 
be  kept  carefully  corked  until  the  moment  it  is  used.  The  experiment 
should  be  made  upon  half  a  pint  of  the  suspected  water;  and,  if  the 
contamination  is  supposed  to  be  caused  by  lead  pipes,  it  is  a  good  plan  to 
test  a  portion  of  the  liquid  which  has  stood  over  night  in  the  condiiits. 
The  mode  of  discriminating  the  precipitate  caused  by  iron  from  those 
due  to  the  dangerous  metals,  load  and  copper,  is  to  let  fall  a  few  drop 
of  hydrochloric  acid,  called  also  muriatic  acid,  into  the  fluid.  If  the 
brownish  or  yellowish-brown  tint  disappears,  we  may  laiow  that  iunocent 
iron  is  the  only  metallic  impurity;  whilst  if,  on  the  contrary,  no  change  is 
effected  by  the  addition  of  the  acid,  one  of  the  poisonous  metals,  lead  or 
copper,  is  present.  ISTo  water,  however,  in  which  the  slightest  tinge  is 
produced  by  adding  the  suli)hide  of  ammonium,  should  be  swallowed  by 
man  or  beast  until  a  rigid  investigation  by  a  competent  water-analyist 
has  proved  it  to  be  harmless. 

Difficulty  of  Obviating  Lead  Poisoning. — Attempts  have  been  made  to 
obviate  the  danger  of  water  contamination  from  lead  pipes  in  various 
ways,  but  not  as  yet  with  complete  success.  In  some  instances  the  pipes 
have  been  lined  with  other  metals,  such  as  tin  or  zinc ;  but,  at  least  in 
some  instances,  a  galvanic  action  has  thus  been  sot  up,  which  corroded 
the  conduits  with  great  rapidity,  and  probably  led,  therefore,  to  still  more 
dangerous  pollution  of  the  water  supply.  Coating  the  pipes  on  the  inside 
with  coal-tar.  bituminous  varnish,  solution  of  g-utta-percha  and  of  India- 
rubber,  have  also  been  experimented  with,  as  yet  with  but  partial  success. 

Lead  Difieases — The  injurious  effects  of  lead  ui>on  the  humau  system 


156  WATER  IN  ITS   HYGIENIC   KELATIONS. 

are  displayed  first,  in  the  production  o£  dyspepsia;  later,  obstinate  con- 
stipation and  a  peculiar  kind  of  colic,  so  common  among  painters  from  the 
influence  of  lead  that  it  has  received  the  name  of  "painter's  colic;"  and 
finally,  disturbance  of  the  nervous  system,  especially  that  peculiar  form  • 
of  lead-palsy  called  wrrst-drop,  in  which  the  power  to  lift  up  the  hand  is 
more  or  less  com])]otely  lost. 

Iron  in  Water — The  presence  of  iron  in  a  water,  rendering  it  what 
is  called  Chalybeate,  from  tlie  old  Greek  name  for  iron,  renders  it  to  many 
persons  only  a  useful  tonic,  but  in  some  people  it  causes  severe  headache 
and  serious  disturbance  of  the  digestive  organs. 

Arsenic  in  Water — Arsenic,  coj^per  and  mercury  are  rarely  found 
in  drinking  waters  in  America,  except  in  streams  flowing  near  chemical 
works,  or  unless  they  are  introduced  designedly  with  some  murderous 
intention.  These  metals  may,  therefore,  be  practically  ignored  in  the 
consideration  of  water  from  a  hygienic  point  of  view. 

Infectious  Diseases  from  Impure  Water — The  principal  acute  diseases 
wliicli  arc  due  to  impure  water  are  Cholera,  Typlioid  Fever,  Piarrhcea  and 
Dysentery;  and,  although  it  is  only  within  a  comparatively  recent  period 
that  mankind  has  begun  to  realize  its  dangers  from  this  source  of  these 
maladies,  the  accumulated  evidence  is  already  very  conclusive. 

Cholera  Due  to  Impure  Water. — Among  the  remarkable  outbreaks 
which  go  to  prove  that  this  mode  of  cholera  propagation  is  not  at  all  im- 
common,  may  be  mentioned  the  following,  condensed  from  Mr.  Simons' 
eighth  report  as  medical  officer  of  the  English  privy  council,  during  the 
prevalence  of  cholera  in  England  in  18G5 :  A  gentleman  and  his  wife 
from  the  village  of  Theydon-Bois,  in  Essex,  had  been  lodging  at  the  town 
of  Weymouth  for  tAvo  or  three  weeks,  and  returned  home  towards  the  end 
of  September.  On  their  way  home  they  passed  through  Dorchester, 
where  the  gentleman  was  seized  with  diarrhoea,  vomiting  and  cramps, 
which  continued  more  or  less  during  the  next  day  and  the  day  following, 
when  he  reached  his  own  home.  During  the  journey  the  wife  also  began 
to  complain  of  pains  in  the  abdomen,  which  was  followed  by  diarrhoea  and 
eventually  by  cholera,  from  which  she  died. 

Cholera  Infection. — A  few  days  after  their  return  the  same  terrible 
disease  rapidly  attacked  other  members  of  the  household,  so  that,  within 
a  fortnight,  in  that  one  little  circle,  eleven  persons  had  been  seized  with 
cholera,  including  the  mother,  father,  grandmother,  two  daughters,  son, 
doctor,  serving-lad,  serving-mlaid,  laborer  and  coimtry-woman,  and  of 
these  eleven  only  three  survived,  namely,  the  son,  a  daughter    and  the 


TEST  FOE  LEAD  rOISON.  157 

serving-laJ.  Later,  in  the  country-woman's  family,  there  was  another 
fatal  case.  It  cannot  well  be  doubted,  concluded  Mr.  Simon,  but  that  the 
exciting  cause  of  this  succession  of  events  was  in  some  way  or  other  the 
return  of  the  parents  from  Weymouth — of  the  father  with  the  remains 
of  choleraic  diarrhoea  upon  him,  of  the  mother  with  apparently  the  begin- 
nings of  the  same  complaint.  But  this  is  only  part  of  the  case,  and  the 
remainder  teaches  a  most  impressive  lesson.  All  the  drinking  water  used 
in  the  house  came  from  a  well  beneath  the  floor  of  the  scullery,  and  into 
that  well  there  was  habitual  soakage  from  the  water-closet. 

Another  Case  of  Infection.— Another  famous  illustration  is  found  in 
the  history  of  the  "tea-water  pump"  of  Broad  street,  near  Golden 
Square,  London,  which  during  the  cholera  visitation  of  1854,  killed 
nearly  500  persons  in  a  single  week,  in  one  of  the  fashionable  localities  of 
the  city.  It  has  long  been  kno-nm  that  water  containing  five  or  six  grains 
of  lime  and  magnesia  to  the  gallon  is  much  to  be  preferred  for  making  tea 
to  water  of  any  other  quality.  This  is  because  the  lime  precipitates  the 
astringent  matter  of  the  leaf,  yet  does  not  interfere  with  the  solution 
of  the  desirable  constituents;  and  hence  certain  wells  which  have  this 
proper  proportion  of  mineral  matter  come  to  be  valued  very  highly  by 
persons  of  nice  taste. 

The  Famous  London  Pump. — At  any  rate,  the  Broad  street  pump  had 
in  London  the  reputation  of  furnishing,  in  its  cold  sparkling  waters, 
a  better  medium  for  "the  cup  which  cheers  but  does  not  inebriate,"  than 
was  elsewhere  to  be  found.  When  the  cholera  invaded  this  neighborliood 
the  wealthy  residents  retired  to  the  fashionable  suburbs  which  were  still 
uninfected ;  but,  to  the  surprise  of  many,  the  cholera  broke  out  among 
them  with  terrible  severity.  The  health  officers  soon  discovered,  however, 
that  those  who  were  attacked  had  sent  in  every  day  to  their  favorite  Broad 
street  pump  for  their  water-siipply,  and,  by  removing  the  pump-handle, 
they  quickly  put  an  end  to  the  epidemic. 

Avoiding  Cholera — A  first  and  highly  important  warning,  therefore, 
which  these  and  many  other  similar  occurrences  give  us  is  never  to  drink 
any  water  which,  by  any  possibility,  could  have  become  contaminated 
with  the  smallest  pnrticle  of  discharge  from  the  bowels  of  a  person  suffer- 
ing from  cholera  or  choleraic  diarrhoea. 

Typhoid  Fever  from  Polluted  Water — The  remarks  which  have  been 
already  made  with  regard  to  the  influence  of  impure  water  on  the  spread 
of  cholera,  apply  still  with  greater  force  to  the  causation  of  typhoid  fever. 
So  common  is  this  mode  of  propagation  that  the  assertion  may  be  ventured 


158  WATEE    IN    ITS   HTOIENIO   EELATIONfl, 

that  few  readers  of  these  pages  have  not  lost  some  near  relative  or  beloved 
frieud  from  thia  dreaded  disease  arising  in  this  way,  although  the  true 
source  of  the  infection  ■  was  perhaps,  at  the  time  it  occurred,  quite  un- 
suspected. 

Spread  of  Typhoid. — Sir  William  Jenner,  than  whom  no  higher  medi- 
cal authority  could  well  be  quoted,  in  commenting  upon  this  point,  says: 
Tlie  spread  of  typhoid  fever  is,  if  possible,  less  disputable  than  the  spread 
of  cholera  by  the  same  means ;  solitary  cases,  outbreaks  confined  to  single 
houses,  to  small  villages  and  to  parts  of  largo  towns,  cases  isolated  it  seems 
from  all  sources  of  fallacy,  and  epidemics  affecting  the  inhabitants  of 
large  though  limited  localities,  have  all  united  to  support,  by  their  testi- 
mony, the  truth  of  the  opinion  that  the  admixture  of  a  trace  of  excrement, 
but  especially  of  excrement  from  a  typhoid-fever  patient,  with  the  water 
supplied  for  drinking  purposes,  is  the  most  efficient  cause  of  the  spread 
of  the  disease,  and  that  the  diffusion  of  the  malady  in  any  given  locality 
is  limited  or  otherwise,  and  limited  just  in  proportion  as  the  dwellers 
in  that  locality  derive  their  supply  of  drinlcing  water  from  polluted 
sources. 

Deadly  Effect  of  Water  Impurity. — ^According  to  the  late  Dr.  William 
Budd,  it  also  appears  to  bo  higlily  probable  that,  when  the  poison  of 
typhoid  fever  enters  the  system  by  drinl'cing  water,  infection  is  much  more 
certain  than  when  it  is  disseminated  by  the  air  and  is  breathed  into  the 
lungs.  In  support  of  this  statemient,  he  instances  an  outbreak  which 
occiirrcd  in  Wales,  where  out  of  ninety  or  a  hundred  persons  who  attended 
a  ball,  fully  one-third  was  shortly  afterward  laid  \ip  with  fever.  Although 
the  water  was  not  examined,  there  was  satisfactory  reason  to  believe  that 
it  was  polluted  with  sewage. 

Typhoid  Poison  from  a  Well. — In  a  report  of  the  American  Public 
Health  Association,  Dr.  Austin  Flint  gives  an  account  of  an  outbreal-- 
of  typhoid  fever  in  Vermont  which  it  was  possible  to  trace,  in  the 
most  circumstantial  way,  to  the  jioisoniug  of  a  well  in  some  such 
method  as  has  been  described.  A  young  man  traveling  through  that  region 
by  stage-coach  was  taken  ill,  and,  when  he  could  go  no  further,  was 
left  at  a  tavern  in  a  little  hamlet  to  be  cared  for,  his  fllness  soon  proved 
to  be  typhoid  fever.  A  small  watercourse,  in  a  shallow  valley,  divided 
the  village  into  two  portions,  each  of  which  consisted  of  half  a  dozen 
houses  or  less.  In  a  few  days  new  cases  of  the  fever  made  their  appear- 
ance in  that  part  of  the  hamlet  to  which  the  tavern  belonged — every  house. 


IHTECTIONS  FROM  WATER.  159 

in  fact,  but  one  was  invaded  with  this  disease — ^whilst  on  the  other  side 
of  the  stream  not  a  case  occurred.  It  appears  that  the  tavern  well,  which 
was  the  only  one  upon  that  side  of  the  village,  furnished  the  water-siipply 
to  all  the  families  belonging  there  hut  one.  That  one  family  had  had  a 
quarrel  with  the  landlord  of  the  hotel,  had  consequently  deserted  the 
tavern  well  for  a  more  distant  supply  of  drinking  water,  and  so  escaped 
swallowing  the  specific  poison  of  typhoid  fever  in  the  water  by  which  all 
their  neighbors  were  stricken  down. 

Typhoid  from  Milk. — It  has  also  been  proven  in  late  years  that 
typhoid  is  transmitted  from  infected  milk,  cows  have  been  allowed  to 
drink  from  streams  that  have  had  the  discharges  from  tyjjhoid  patients 
thrown  into  them.  The  germs  have  been  taken  into  the  cows  and  finally 
into  the  milk.  This  milk  was  distributed  to  families  and  in  many  cases 
caused  tyjjhoid. 

Proximity  of  Privy  and  "Well. — Unless  privy  and  well  be  located  at 
considerable  distance  from  each  other,  and  further  unless  the  nature  of 
the  groimd  be  such  that  the  flow  from  the  privy  will  be  away  from  the 
sources  of  the  well,  there  is  always  grave  danger  of  the  pollution  of  the 
well  water  with  germs  from  the  privy.  This  also  applies  to  nearby 
stable  yards.  There  are  many  authenticated  cases  of  typhoid  which  have 
been  directly  traced  to  the  proximity  of  wells  to  privies  and  stables,  and 
the  danger  should  not  be  underestimated. 

Danger  in  Farm-houses  from  Polluted  Water. — Of  course,  the  same 
conclusion  holds  good  for  country  farm-houses  or  dwellings  when,  from 
motives  of  convenience,  although  there  is  space  enough  and  to  spare, 
but  a  short  distance  is  interposed  between  the  sides  of  the  hole  which  is 
called  the  well,  and  which  furnishes  the  drinking  water,  and  the  other 
hole  nearby  which  is  called  the  cess-pit,  and  used  as  a  receptacle  for  filthy, 
often  poisonous,  excrement.  Moreover,  there  are  no  doubt  many  instances 
where,  owing  to  the  inclination  of  beds  of  sand  or  gravel,  strata  of  rock 
and  so  forth,  impurities  of  these  and  other  dangerous  varieties  may  be 
carried,  by  underground  currents,  much  further  than  the  distances  which 
have  been  mentioned  as  measured  upon  the  surface  of  the  earth.  In 
other  words,  a  cess-pool  on  a  hill-side,  500  feet  or  more  away  from  a  well, 
may  infect  the  water  of  the  latter,  if  underground  currents  favor  such 
contamination. 

Diarrhoea  and  Dysentery  from  Impure  Water. — The  instances  of  out- 
breaks of  these  two  diseases  from  contaminated  water-supply  are  very 


ICO  WATKIt  IN   ITS   ITYOIENIC   RELATIONS. 

luinierous,  and  probal)l_y  most  persons  can  recall  examples  of  this  kind. 
The  impurities  which  produce  diarrhoea  and  dysentery  are  suspended 
earthy  matters,  such  as  are  found  in  most  river-waters  after  a  rain;  sus- 
pended animal  and  vegetable  material ;  sulphates  and  chlorides  of  lime 
and  magnesia,  and  nitrates  of  ammonia  and  of  lime.  Besides  the  nu- 
merous outbreaks  traceable  to  direct  sewage  contamination,  there  are 
several  instances  recorded  of  indirect  |X)isoning  of  a  water-supply  from 
this  source,  as  in  the  following  curious  case. 

Outbreak  at  Salford  Jail. — In  the  Salford,  England,  jail  there  was 
a  sudden  outbreak  of  diarrhoea  of  a  choleraic  type,  which  affected  more 
than  half  of  the  prisoners;  while  of  the  officers  and  their  families,  who 
were  distributed  throughout  the  building,  not  one  was  attacked.  The 
food  of  the  convicts  was  examined  and  found  to  be  good;  it  was  evident, 
also,  that  the  air  did  not  contain  the  cause  of  the  disease,  because  both 
classes  above  mentioned  were  under  the  same  conditions  in  that  respect. 
Suspicion  was  therefore  directed  to  the  drinking-water.  It  was  then  dis- 
covered that,  though  the  water  supplying  all  parts  of  the  prison  was 
derived  from  the  same  source,  there  was  one  cistern  for  the  use  of  the 
officers,  and  another  covered  cistern  for  furnishing  to  the  prisoners  their 
allowance,  and  that  the  untrapped  overflow-pipe  of  the  latter  com- 
municated with  an  open  sewer.  On  the  day  of  the  outbreak  of  diarrhoea 
in  the  jail,  the  water  from  this  cistern  was  observed  to  be  colored  and  to 
taste  unpleasantly. 

Sewer-Gas  Poison. — It  had  obviously  absorbed  cewer  gas,  which  had 
ascended  through  the  overflow-pipe,  and  that  this  had  been  the  real  cause 
of  the  disease  was  indicated  by  the  fact  that  the  diarrhoea  disappeared 
almost  as  rapidly  as  it  had  broken  out,  when  the  cistern  was  emptied  and 
the  pipe  efficiently  trapped. 

Diarrhoea  in  Country  Districts. — Dr.  Wilson  declares  that,  according 
to  his  experience,  much  of  the  diarrhoea  which  prevails  in  country  districts 
during  the  summer  and  autumn  amongst  children  is  due  to  polluted  water, 
drunk  either  as  it  is  drawn  from  the  well  or  when  mixed  with  milk,  fraud- 
ulently or  by  accident. 

Impure  Ice  as  a  Cause  of  Diarrhoea. — The  fact  that  ice  is  now  used  by 
almost  all  classes  to  an  extent  which  entitles  it  to  rank  rather  as  a  necessity 
than,  as  formerly,  as  a  luxury  of  life,  renders  it  important  that  its  purity 
should  be  as  jealously  guarded  as  the  water-supply.  It  is  popularly  be- 
lieved that  water  frees  itself  from  dangerous  organic  matter,  as  it  does  to 
a  great  degree  from  certain  saline  contaminations  during  the  process  of 


TYPHOID  FROM   IMPURE   WATER. 


161 


freezing,  and  also  that  the  vegetable  or  animal  germs  of  typhoid  and  otliOT 
fevers  are  killed,  or  at  least  rendered  sterile,  by  congelation  of  the  water 
in  which  they  exist.  Both  these  ideas  are,  however,  unquestionably  er- 
roneous, as  has  been  repeatedly  proved  by  the  various  experiments  which 
ignorant  hotel-keepers  try  without  the  least  intending  it,  upon  their  guests, 
on  a  scale  which  would  make  the  boldest  vivisector  stand  aghast  before 
the  suffering  inflicted,  even  if  it  were  only  upon  the  brutes  which  form 
the  subjects  of  his  researches. 

A  Case  of  Impure  Ice  Poison. — Such  was  notably  the  case  in  an  epi- 
demic of  intestinal  disorder  which  occurred  at  the  watering-place  of 
Eye  Beach,  IST.  H.  From  the  account  of  Dr.  Nichols,  who  attended 
most  of  the  patients,  it  seems  that,  early  in  the  season,  a  mild  form  of 
disturbance  of  the  stomach  and  bowels  made  its  appearance  among  the 
guests  of  a  particular  hotel  at  this  favorite  summer  resort.  The  symptoms 
were  in  general  giddiness,  nausea  or  vomiting,  diarrhcea  and  severe  ab- 
dominal pain,  accompanied  by  fever,  loss  of  appetite  and  mental  depres- 
sion. The  well  and  drainage  system  of  the  establishment,  which  had  re- 
cently been  put  in  complete  order,  was  found  almost  faultless,  and  the 
milk-supply  of  unquestionable  purity;  but  on  the  attention  of  the  phy- 
sician being  directed  to  the  stock  of  ice  provided  for  the  guests,  conclu- 
sive proof  of  its  dangerous  qiiality  was  promptly  obtained. 

The  Contaminated  Ice  Pond — Both  the  house  in  which  the  ice  was 
stored  and  the  water  from  the  melted  ice  gave  off  a  decidedly  disagi-eeable 
or  even  offensive  odor.  Finally,  a  visit  to  the  pond  from  which  the  ice 
had  been  gathered  disclosed  the  fact  that  much  of  the  water  in  it  was 
dark-colored,  foul  and  highly  contaminated  with  filthy  marsh-mud  and 
decomposing  saw-dust.  Chemical  analysis  showed  that  both  it  and  the 
suspected  ice  contained  a  large  excess  of  organic  and  volatile  impurities, 
including  four  one-hundredths  of  a  grain  per  gallon  of  albuminoid  am- 
monia. 

Fever  Germs  in  Ice In  Connecticut,  the  Board  of  Health  informs 

us  that,  in  several  instances,  attention  has  been  drawn  to  sewage-con- 
taminated ponds  with  ice-houses  upon  their  borders,  and  that  several 
isolated  cases  of  typhoid  fever,  and  one  death,  from  the  free  use  of 
ice  polluted  by  sewage,  had  been  recorded  in  that  State.  The  curious 
natural  experiment  of  the  United  States  steamship  Plymouth,  elsewhere 
detailed,  shows  conclusively  that  fever  germs  are  not  infallibly  destroyed 
by  a  freezing,  probably  not  by  a  zero  temperature,  and  contributes 
11 


162  WATEE  IN   ITS    IITGIENIC    RELATIONS. 

its  sliare  of  jiroof  that  impure  ice,  especially  when  gathered  from  ponds 
polluted  by  sewage,  may  constitute  a  prolific  cause  of  disease. 

Dangers  in  Snow-Water.^ — Snow-water,  pure  and  fresh  as  it  seems 
may  be  very  dangerous  to  health  in  consequence  of  organic  impurities 
contained  in  it. 

Mountain  Fever,  Kocky  Mountain  Spotted  Fever  or  Tick  Fever. — An 
acute  infectious  disease  characterized  by  chill,  continued  fever,  headache, 
pains  in  the  joints  and  bones  and  an  eruption  on  the  ankles  and  wrists ; 
later  all  over  the  body.  It  attacks  all  ages  and  both  sexes  usually  in  the 
months  of  May  and  June. 

Stmptoms  and  Teeatment. — The  disease  follows  a  course  of  two  to 
three  weeks  with  a  temperature  of  103  to  105.  The  bowels  are  constipated 
and  crushing  pains  in  the  limbs  are  quite  common.  The  tongue  is  furred 
and  nose  bleeding  is  quite  common.  JSTausea  and  vomiting  may  appear 
during  the  second  week.  A  mild  type  of  the  disease  without  any  eruption 
is  said  to  occur  at  times. 

There  is  no  specific  treatment.  The  patient  should  be  protected  from 
noise  and  kept  in  a  dark  room.  The  diet  should  be  liquid.  When  tem- 
perature is  high  sponge  baths  should  be  used.  Phenacetine  and  other  an- 
tipyretics are  used.  Free  purgation  with  calomel  and  salines  are  fre- 
quently used. 

Ague  from  Impure  "Water. — Although  the  poison  of  fever  and  ague 
is  probably,  as  a  general  rule,  conveyed  into  the  human  system  by  the 
bite  of  mosquitoes,  some  cases  seem  to  show  that  it  may  also  enter  the 
body  by  drinking  water. 

Diarrhoea  Outbreak  from  Impure  Water.— ^As  general  conclusions  in 
regard  to  contaminated  water,  it  may  be  stated  that:  1st.  An  outbreak 
of  diarrhoea  arising  in  a  community  is  almost  always  owing  to  impure  air, 
impure  water,  or  bad  food.  If  it  affects  a  number  of  persons  suddenly  it 
is  probably  due  to  one  of  the  last  two  causes,  and  if  it  extends  over  many 
families,  almost  certainly  to  water.  But,  as  the  cause  of  impurity  may  be 
trausient,  it  is  not  always  easy  to  find  experimental  proof. 

Dysentery  Outbreaks  from  Impure  Water — 2d.  Diarrhoea  or  dys- 
entery constantly  affecting  a  community,  or  returning  periodically  at 
certain  times  of  the  year,  is  far  more  likely  to  be  produced  by  bad  water 
than  by  any  other  cause. 

Cholera  Outbreaks  from  Impure  Water — 3d.  A  very  sudden  and 
localized  outbreak  of  either  typhoid  fever  or  cholera  is  almost  certainly 
onang  to  the  introduction  of  the  poison  by  water. 

Malarial  Outbreaks  from  Impure  Water — 4th.  The  same  statement 
is  true  in  cases  of  ague  or  malarious  fever;  and,  especially  if  the  attacks 


DISEASES  DUE  TO  IMPURE  WATEE.  163 

are  serious,  a  possible  introduction  by  foul  water  should  be  carefully 
inquired  into. 

Worms  from  Impure  Water— 5th.  The  introduction  of  the  eggs  of 
some  of  the  intestinal  worms,  by  means  of  driniing  water,  is  proved  in 
some  instances  and  rendered  highly  probable  in  many  others.  People 
residing  in  districts  where  shallow-dip-  and  draw-wells  are  in  common  use, 
seem  to  be  particularly  subject  to  parasitic  worms  in  the  bowels. 

Pure  Water  a  Sanitary  Necessity. — 6th.  Although  it  is  not  possible 
at  present  to  assign  to  every  impurity  in  water  its  exact  share  in  the 
production  of  disease,  or  to  prove  the  precise  evil  influence  on  the  public 
health  of  water  which  is  not  extremely  impure,  it  appears  certain,  says 
Dr.  Parkes,  that  the  health  of  a  community  always  imi^roves  when  an 
abundant  and  pure  water-supply  is  given;  and,  apart  from  this  actual 
evidence,  we  are  entitled  to  conclude  from  other  considerations,  that 
abundant  and  good  water  is  a  primary  sanitary  necessity. 

Rocks  Yielding  Pure  Water — As  a  general  giiide  to  the  water  im- 
purities that  may  be  exjjected  in  waters  from  the  various  geological  fornia- 
tions  enumerated,  the  following  condensed  summary  of  the  best  known 
facts,  as  given  by  Dr.  Parkes,  will  prove  useful.  The  gi-anitic,  meta- 
morphic,  trap-rock  and  clay-slate  waters  are  generally  very  pure,  often 
not  containing  more  than  from  two  to  six  grains  per  gallon  of  solid  matter, 
which  is  chiefly  made  up  of  carbonate  and  chloride  of  sodium,  with  a  little 
lime  and  magnesia.  The  orgauic  matter  is  very  small  in  amount  usually, 
but  shallow  wells  in  disintegi-ated  trap-rock  may,  of  course,  be  fouled  by 
surface  washings  or  soakage.  The  water  from  millstone  grit  and  hard 
oolite  is  also  very  pure,  sometimes  containing  only  four  gi-ains  per  gallon 
of  mineral  matters,  which  comprise  the  same  saline  materials  as  are  found 
in  granitic  waters,  with  the  addition  of  sulphates  and  a  trace  of  iron. 

Rocks  Yielding  Impure  Water — Soft  sand-rock  waters,  on  the  con- 
trary, are  often  impure,  containing  much  sodium  chloride  or  common 
salt,  sodium  carbonate,  sodium  sulphate,  iron  and  a  little  lime  and  mag- 
nesia, amounting  altogether  to  from  thirty  to  eighty  grains  per  gallon. 
The  organic  matter  may  also  be  abundant;  that  is,  to  the  extent  of  from 
four  to  eight  grains  to  the  gallon,  or  even  more.  Occasionally,  however, 
these  waters  are  quite  pure. 

Sand  and  Gravel  Waters — The  loose  sand  and  gravel  waters  also  vary 
much  in  their  composition,  and  in  tolerably  pure  gi'avels,  not  near  towns, 
the  water  is  often  very  free  from  contamination.  In  many  sands,  which 
are  rich  in  salts,  the  water  percolating  through  them  is,  of  course,  much 
affected,  the  dissolved  solids  amounting  sometimes  to  seventy  grains  per 
gallon,  and  consisting  of  sodium  chloride,  sodium  carbonate,  sodium  sul- 


164  WATER  IN  ITS  HYGIENIC  EELATION8. 

]>liatc,  "n-itb  calcium  and  magnesium  salts,  and  a  good  deal  of  organio 
matter.  The  water  from  the  sandy  plains  of  southern  France  is  said  to 
coritain  enough  organic  matter  to  j^roduce  ague  in  those  who  drink  it. 

Chalky  Waters. — The  typical  "hard"  water,  from  chalk  formations, 
ij  very  sparkling  and  clear,  highly  charged  with  carbonic  acid,  and  con- 
tains from  seven  to  twenty  grains  of  calcium  carbonate,  a  little  magnesium 
carbonate  and  sodium  chloride,  with  small  and  immaterial  quantities  of 
iron,  silica,  potassa,  nitric,  sulphuric  and  phosphuric  acids  in  combination; 
organic  matter  is  usually  in  small  amount,  and  is  therefore  a  good,  com- 
paratively wholesome  and  pleasant  water,  whichj  though  hard,  softens 
greatly  by  boiling. 

Limestone  Waters. — The  waters  from  limestone  and  magnesian  lime- 
stone regions  are  also  clear,  sparkling  liquids,  of  agreeable  taste,  but  they 
differ  from  the  chalk  waters  in  that  they  contain  usually  more  calcium 
sulphate,  the  sulphate  of  lime  or  gypsum,  sometimes  to  the  amount  of 
twelve  grains  per  gallon,  and  in  dolomitic  districts  much  magnesium  sul- 
2)hate  and  carbonate.  They  are  not  so  wholesome  as  the  chalk  waters,  arc 
Lard  and  soften  less  on  boiling. 

Clay  Waters. — The  water  of  clayey  districts  is  chiefly  surface,  and 
Soon  runs  into  converging  streams.  They  often  contain  much  suspended 
matter  in  the  form  of  mud,  but  few  dissolved  constituents.  Waters  from 
the  mixture  of  sand  and  clay  brought  down  by  the  rivers,  perhaps  of 
former  ages,  and  called  Alluvium,  are  generally  impure. 

Alluvial  Waters — The  alluvial  waters  contain  calcium  carbonatie  and 
sulphate,  magnesium  sulphate,  sodium  cldoride  and  carbonate,  iron,  silica, 
and  often  much  organic  matter,  the  total  amount  of  solids  reaching  120 
gTains  or  more.  Occasionally  the  organic  matter  oxidizes  rapidly  into 
nitrites,  and,  if  the  quantity  of  chloride  of  sodium  is  large,  it  might  be 
incorrectly  supposed,  from  analysis,  that  it  was  contaminated  with  sewage. 

Surface  Waters. — Surface  and  subsoil  waters  are  often  highly  impure, 
and,  although  very  variable  in  com.position,  are  always  to  be  regarded 
with  suspicion  until  proved  to  be  safe. 

Soil  Waters. — Some  soils  contain  potassium,  sodium  and  magnesium 
nitrates,  and  give  up  these  salts  in  abundance  to  water  which  soaks  through 
them.  In  towns,  and  among  human  habitations,  the  surface  and  shallow- 
well  water  is  often  very  unsafe,  as  already  explained.  It  may  contain 
large  quantities  of  calcium  and  sodium  nitrates,  nitrites,  sulphates,  plios- 
phates  and  chlorides.  Organic  matter  exists  often  in  large  amoimt  and 
slowly  oxidizes,  forming  nitric  acid  and  ammonia. 


QUALITY    OI"    VARIOUS    WATEES.  165 

Marsli  Waters. — Marsh-water  always  contains  a  large  quantity  of 
vegetable  organic  matter,  it  being  not  unusual  to  find  from  twelve  to  forty 
grains  per  gallon,  and  sometimes  even  more.  Suspended  organic  matter 
is  also  common,  but  the  amoimt  of  saline  impurity  is  very  variable. 

Poisoned  Waters  from  Graveyards In  water  from  graveyards,  am- 
monium and  calcium  nitrites,  and  sometimes  fatty  acids,  with  much 
organic  matter  of  animal  origin,  are  met  with.  The  water  of  a  well  at  St. 
Didier,  France,  more  than  300  feet  from  a  cemetery,  was  found  to  be 
largely  contaminated  with  ammoniacal  salts  and  organic  matter,  which 
was  left  on  evaporation.  The  water  was  clear  at  first,  but  had.  a  vapid 
taste  ad  speedily  became  putrid. 

Artesian-Well  Waters — Artesian-weU  water  varies  greatly  in  com- 
position, being  so  highly  charged  with  saline  matter  sometimes  that  it  is 
quite  undrinkable.  The  artesian  well  at  Grenelle,  France,  contains 
enough  sodium  and  potassium  carbonates  to  render  it  alkaline  to  the  taste, 
although  it  is  used  for  the  water-supply  of  the  town.  In  some  cases 
artesian-well  water  contains  an  appreciable  amount  of  iron;  in  other 
instances,  when  drawn  from  the  lower  part  of  the  chalk  formation,  or  the 
green  sand  below  it,  it  is  tolerably  pure.  The  temperature  of  the  water 
is  iisually  high  in  proportion  to  the  depth  of  the  well.  Thus,  for  example, 
a  well  at  Louisville,  Kentucky,  bored  to  the  depth  of  over  2000  feet, 
discharges  an  immense  volume  of  water,  the  temperature  of  which  is 
75  degrees  Fahrenlieit.  The  amount  of  air  in  the  water  of  deep  artesian 
wells  is  often  small,  and  this  circumstance,  with  the  frequently  elevated 
temperature  and  high  degree  of  saline  impregnation,  is  apt  to  make  stich 
wells  very  unsatisfactory  as  sources  of  water-supply. 

Seashore-Well  Waters. — Lastly,  water  from  wells  near  the  seashore 
is  apt  to  be  brackish  and  objectionable  on  that  account,  even  thougli  it 
does  not  contain  much  organic  matter.  Dr.  Parkes  mentions  one  instance 
where  a  bored  well,  150  feet  deep,  near  the  sea,  yielded  water  impi-egnated 
with  500  grains  of  solids,  including  380  grains  of  chlorides,  per  gallon. 

THE  DETECTION  OF  CONTAMINATED  WATER. 

Vigilance  Over  Drinking  Water. — As  a  general  rule,  the  examination 
of  drinking  water,  in  order  to  determine  its  purity,  and  consequent  safety 
as  a  beverage,  involves  a  chemical  and  microscopical  analysis,  which  shoidd 
always  be  made  when  circumstances  permit.  Moreover,  it  must  not  bo 
forgotten  that  water  which  is  usually  pure  and  wholesome,  may  be  at  any 


166  WATER    IN    ITS    nYGIETTIC    RELATIONS. 

time  jiolluted  by  the  fouling  of  its  source  during  heavy  rains,  the  occur- 
reuce  of  floods,  the  alteration  iu  the  customary  course  and  flow  of  sewage, 
manufacturing  refuse,  and  so  forth,  above  or  below  groimd.  Constant 
vigilance  over  the  condition  of  the  water-sujjply  is,  therefore,  exceedingly 
necessary  to  health ;  but  as  complete  investigation  requires  the  skill  of  a 
professed  analytical  chemist,  those  methods  of  examination  need  only 
be  described  in  detail  which  are  especially  used  as  giving  us  warning  of 
danger,  with  a  few  of  the  simpler  tests. 

Character  of  Water  Tests. — For  hygienic  purposes,  then,  we  examine 
water  in  order  to  discover  whether  it  contains  any  suspended  or  dissolved 
ingredients  which  are  likely  to  be  hurtful.  Some  saline  materials  often 
found  in  water,  as  already  mentioned,  are  not  injurious  when  present  in 
small  quantities  only,  wliilst  others,  consisting  of  or  resulting  from  putre- 
fying animal  matter,  are  at  once  recognized  as  very  dangerous  to  health. 
In  any  instance,  reliance  must  not  be  placed  upon  the  results  of  single 
tests,  bat  all  the  circiunstances  of  the  case  must  be  searched  out  and  care- 
fully considered. 

Green  Waters — Green  waters  generally  owe  their  color  to  vegetable 
matters,  chiefly  microscopic  plants,  and  are  usually  harmless,  although 
certain  bluish-green  plants  of  this  kind  give  rise  to  the  disagi'eeable  smell 
popularly  denominated  the  pig-pen  odor,  and  probably  render  the  fluid 
unwholesome  as  well  as  disgusting. 

Yellow  Waters. — Yellow  or  brown  waters  are  the  most  to  be  feared, 
as  their  color  is  often  due  to  animal  organic  matter,  such  as  sewage.  It 
is  sometimes  the  case,  however,  that  a  yellow  or  brown  tint  is  due  to  de- 
composed vegetable  material,  such  as  peat,  or  decayed  wood,  and  the  fluid 
is  then  merely  unjileasant  and  not  hurtful.  Water  is  also  occasionally 
colored  in  this  way  by  some  salt  of  iron,  although  in  most  instances  the 
metal  is  precipitated  as  oxide  of  iron  in  the  sediment. 

Microscopic  Tests.- — The  lustre  or  brilliancy  of  a  water,  which  is 
recommended  as  a  good  test  as  to  the  amount  of  air  which  a  specimen 
contains,  can  readily  be  judged  by  the  eye;  but  the  only  satisfactory 
examination  of  the  sediment  must  be  made  with  the  microscope,  which 
ought  to  have  a  power  of  about  two  hundred  and  fifty  diameters,  although 
even  an  instrument  of  half  that  capacity  will  often  reveal  much  of  interest 
and  importance  in  the  deposit  of  a  suspected  drinking  water. 

Taste  Not  a  Good  Water  Test. — The -taste  of  a  water  is  a  very  uncer- 
tain indicatifln  in  regard  to  wholesomeness.  Of  course,  any  badly-tasting 
water  ought  at  once  to  be  rejected,  but  some  very  agreeable  waters,  as  far  as 


OOLOB   TEST   OF   WATEE.  167 

tHeIr  tagt'es  are  concerned,  have  proved  to  be  dangerously  contaminated 
with  sewage  of  the  vilest  character.  And  yet  many  people  are  to  he 
found  all  over  the  country  who  think  that  if  a  water  is  bright  and  clear  it 
must  be  good;  nay,  if  it  is  the  drinking  fluid  of  their  own  wells  which  is 
called  in  question,  they  will  often  indignantly  resent  the  faintest  sugges- 
tion that  it  can  possibly  be  in  the  least  degree  injurious  to  health.  As 
remarked  by  Dr.  Fox,  however,  such  cases  as  that  of  the  servant  who, 
coming  from  an  obscure  village  near  the  Dartmoor,  in  the  southwest  part 
of  England,  objected  to  the  pure  water  of  a  distant  town  where  she  was  in 
service,  becaiise  it  was  devoid  of  both  taste  and  smell,  are  becoming  rare. 

Where  Taste  Test  Fails. — As  regards  dissolved  mineral  matters,  taste 
is  of  little  iise,  and  differs  in  different  persons.  On  an  average, 
common  salt  is  not  recognized  tmtil  it  reaches  the  quantity  of  seventy-five 
grains  per  gallon,  whilst  carbonate  of  lime  is  perceptible  when  dissolved 
in  a  water  to  the  amount  of  ten  grains  per  gallon ;  iron,  however,  can  be 
recognized  by  its  astringent  flavor  in  very  small  quantities,  occasionally 
as  minute  an  impregnation  as  two-tenths  of  a  grain  per  gallon  may  be  thus 
detected.  A  permanently-hard  water  has  sometimes  a  peculiarly  insipid 
or  slightly  saline  taste,  if  the  total  salts  amount  to  thirty-five  or  forty 
grains  per  gallon  and  the  sulphate  of  lime  or  gypsum  to  six  or  eight  grains. 

What  Taste  of  Water  is  Due  to. — The  taste  of  good  drinking  water  is 
due  entirely  to  the  gases  dissolved ;  water  nearly  free  from  the  hardness 
of  carbonate  of  lime,  held  in  solution  by  carbonic  acid,  such  as  distilled 
water,  is  not  so  pleasant  as  the  brisk,  highly-carbonated  waters;  it  may 
be  called  flat,  but  it  is  difficult  to  define  the  kind  of  taste  or  the  absence 
of  it. 

Rules  for  Pure  Water — Although  the  general  characters  of  a  water, 
when  examined  as  directed  above,  give  only  an  imperfect  idea  of  its  value, 
they  are  yet  important  when  no  other  investigation  can  be  made.  If  the 
water  be  colorless,  clear,  free  from  suspended  materials,  of  a  good  lustre, 
yet  not  too  brilliant,  devoid  of  smell  and  taste,  except  such  as  are  recog- 
nized as  characteristic  of  a  safe  and  usable  water,  we  shall  in  a  majority 
of  cases  be  JTistified  in  pronoimeing  it  a  wholesome  drinking  fluid ;  whilst, 
according  to  the  degree  in  which  it  deviates  from  these  characteristics, 
will  we  proportionately  be  sustained  in  regarding  it  with  grave  suspicion. 

Chemical  Tests  the  Best. — Visible  suspended  matter  is  probably  often 
the  most  dangerous,  although  there  is  little  doubt  that  the  microscopic 
germs  of  various  diseases  may  exist  in  small  aggregations  without  being 
recognizable  at  all  by  the  naked  eye  of  even  the  most  practised  observer; 


ICS  WATER  IN  ITS  nYGIENIO  KELATIONS. 

and,  of  course,  the  metallic  impurities,  such  as  lead  and  copper,  for  de- 
tecting which  rules  have  already  been  given,  must  often  escape  discovery 
by  any  examination  which  does  not  include  the  application  of  chemical 
tests. 

Nessler  Test  of  Water — The  one  of  these  chemical  reagents  which 
it  would  be  well  to  apply  in  every  instance  where  it  is  possible  to  do  so, 
is  the  "Xessler's  test,"  an  ounce  of  Avhich  may  be  procured  from  almost 
any  good  chemist  for  twenty  or  twenty-five  cents.  It  constitutes  a  test 
for  the  products  of  decomposing  animal  matters,  especially  sewage  ma- 
terials, including  human  and  animal  excrement,  and  is,  therefore,  capable 
of  e,'iving  timely  warning  against  the  most  dangerous  of  the  common 
pollutions  of  drinking  waters. 

The  Ammonia  Test. — In  the  whole  round  of  chemical  analysis  there 
is  no  determination  which  surpasses  that  of  ammonia  from  putrefying 
animal  matter  by  this  method  in  point  of  delicacy.  It  is  questionable 
whether  any  other  approaches  it.  Tlie  ISTessler  reagent  is  said  to  be  capable 
of  indicating  one  part  of  ammonia  in  twenty  million  parts  of  water,  and 
even  this  assertion,  surprising  as  it  may  seem,  is  given  as  an  understate- 
ment of  the  delicacy  of  the  test.  Such  being  the  characteristic  of  this 
way  of  calculating  the  ammonia,  the  great  advantage  of  causing  deter- 
minations of  organic  matter  to  depend  on  measurements  of  ammonia  will 
be  manifest  to  every  one. 

Form  of  the  Nessler  Test. — In  order  to  make  use  of  this  reagent,  fill 
an  ordinary  wine-glass  or  small  goblet  which  will  hold  from  two  to  four 
ounces,  nearly  full  of  the  water  it  is  wished  to  examine,  and  add  three 
or  four  drops  of  the  ISTessler's  solution.  If  a  yellow  or  brown  color,  or  a 
brownish  precipitate,  be  produced,  the  water  contains  ammoniacal  salts. 
As  a  rule,  this  should  be  regarded  as  a  very  suspicious  circumstance,  and 
should  the  coloration  be  well  marked,  it  is  almost  sufficient  of  itself  to 
condemn  the  water  for  drinking  purposes.  If  a  milky  or  curdy  precipitate 
is  also  formed,  it  shows  that  the  fluid  is  a  hard  water,  and  more  or  less 
unfit  for  washing.  Should  this  whitish  precipitate  be  excessive,  it  hides 
to  a  certain  extent  the  yellowish  color  indicative  of  ammonia,  so  that  it  is 
necessary  to  take  a  fresh  sample  of  the  water,  add  to  it  a  few  drops  of 
strong  solution  of  caustic  potash  or  soda,  and  after  the  precipitate  of  lime 
which  is  thus  caused  to  fall  has  subsided,  test  for  ammoniacal  compounds 
with  the  ISTessler's  reagent. 

The  Soap-Test  of  Impure  Water — Clark's  soap-test  for  determining 
the  hardness  of  water  is  prepared  by  dissolving  a  small  quantity  of  soap. 


CHEMICAL    TEST    OF    WATEE.  169 

say  one  ounce  in  half  a  pint  of  a  mixture  of  equal  pa'rts  of  alcohol  and 
water.  It  is  used  by  dropping  it  into  a  measured  quantity,  such,  for 
examjile,  as  an  ounce  of  the  water  to  be  tested,  until  the  fluid  when  shaken 
begins  to  form  a  beady  lather — the  relative  number  of  drops  required  to 
produce  this  effect  nearly  indicating  the  comparative  degi-ees  of  hardness 
of  the  Avaters  undergoing  examination. 

Water  Test  Should  Always  be  Made — This  soap-test  may  be  used  to 
decided  advantage  in  all  "hard-water"  districts,  and  every  one  should  test 
his  water-supply  at  the  earliest  opportunity,  with  it,  with  the  !tTessler's 
reagent  for  organic  ammonia  indicating  pollution  by  sewage,  and  with 
the  sulphide  of  ammonium  for  contamination  with  lead.  And  the  appli- 
cation of  these  two  latter  tests  is  important,  even  although  the  drinking 
water  in  question  has  been  in  use  for  a  long  time  by  various  members  of 
a  family  without  apparent  injury,  for  many  instances  are  on  record  in 
medical  books  where  chronic  derangements  of  health  have  been  due  to 
impurity  of  the  water  taken  into  the  stomach,  and  yet  this  source  of  injury 
has  been  entirely  unsuspected  until  a  chemical  examination  of  the  water- 
supply  has  revealed  the  insidious  origin  of  the  trouble. 

Water  Precautions  for  Travelers. — A  wise  precaution  when  traveling, 
especially  in  unhealthy  districts  or  during  an  epidemic  of  any  kind,  is  to 
drink  none  but  boiled  rain-water,  which  you  can  make  sure  has  not  been 
exposed  to  contamination  by  lead  pipes,  roofs  or  cisterns.  To  be  eilectual, 
the  boiling  ought  to  be  continued  briskly  for  half  an  hour  or  longer. 
Rain-water  is  preferable  in  limestone  regions,  because  the  hard  water  con- 
taining lime  is  partially  or  not  at  all  improved  in  this  respect  by  boiling, 
and  gives  rise  to  serious  diarrhoea  in  many  of  those  unaccustomed  to  its 
employment.  Such  hard  water  is  also  probably  one  great  cause  of  the 
very  painful  calculous  disorders. 

HYGIENIC  USE  OF  BATHS. 

Temperature  of  Baths. — Coming  now  to  the  detailed  consideration 
of  water  as  applied  to  tho  hiiman  skin  in  the  form  of  a  bath,  in  order  to 
accomplish  the  important  hygienic  purposes  described,  it  is  obvious,  in 
the  first  place,  that  temperature  has  a  powerful  influence  in  this  respect. 

Cold  Baths — The  range  of  the  cold  bath  varies  more  than  that  of 
any  other  kind,  extending,  as  it  docs,  from  84  degrees  Fahrenheit  down 
to  33  degrees  of  the  same  scale.  The  lower  temperatures  included  be- 
tween these  limits  would,   of  course,    test   the   endurance   of  even  the 


170  WATER  IN  ITS  nTGIEXIC   RELATIONS. 

strongest  to  encounter  safely  the  severe  shock  which  is  generally  produced 
by  the  sudden  application,  and  still  more  the  prolonged  immersion  of  the 
body  in  a  water  so  near  its  freezing-point;  but  from  84  degrees  to  74 
degrees  the  reaction  required  is  so  slight  that  few  persons  who  are  not 
actually  invalids  are  too  feeble  to  manifest  it. 

First  Effect  of  the  Cold  Bath — A  shock  is  experienced  throughout 
the  whole  nervous  system,  more  or  less  severe,  according  to  the  lower 
or  higher  temperature  of  the  fluid,  and  the  contracting  effect  of  the  cold 
aids  the  spasmodic  contraction  occurring  in  the  small  blood-vessels  to 
drive  the  blood  to  the  inner  portions  of  the  body,  and  allow  the  surface  to 
become  quickly  chilled. 

Second  Effect  of  the  Cold  Bath. — But  if  the  cold  is  not  too  severe,  or 
the  individual  is  not  exhausted  by  fatigue,  or  enfeebled  by  disease,  a 
change  in  these  conditions  promptly  manifests  itself  soon  after  leaving 
the  bath,  especially  if  the  skin  is  rapidly  dried  by  friction  with  some 
absorbent  substance.  The  heart  and  pulse  return  to  their  normal  rate 
of  movement,  the  nervous  system  recovers  from  the  sliock  which  it  has 
undergone,  the  blood  flows  back  to  the  surface  of  the  skin,  and  a  glow 
of  renewed  warmth  is  felt  throughout  the  entire  body. 

A  Guide  to  Cold  Bathing. — This  agreeable  change  in  the  condition 
of  the  circulation  and  the  sensations  is  called  the  reaction,  and  constitutes 
our  very  best  guide  to  the  employment  of  cool  or  cold  bathing.  If  the 
water  of  a  bath  has  been  colder  than  is  adapted  to  the  strength  of  an  in- 
dividual's constitution,  reaction  comes  on  but  slowly,  and  several  hours 
may  elapse  before  the  natural  balance  of  the  circulation  is  fully  restored. 
In  such  a  case,  the  hands,  feet  and  nose  remain  chilly,  and  also  cold  to  the 
touch  of  another  person.  The  fingers,  lips  and  indeed  the  whole  face, 
has  a  bluish  tint,  and  a  more  or  less  shrunken  appearance.  The  pulse 
continues  weak  and  slow,  and  languor  and  feebleness  characterize  all  the 
movements.  Of  course,  the  method  of  deriving  the  greatest  amount  of 
benefit  from  these  indications  is  for  each  person  to  cautiously  test  the 
power  of  his  system  to  establish  reaction,  commencing  with  a  bath  of  70 
degrees  or  65  degrees,  and  gradually  descending  the  scale  of  the  ther- 
mometer, as  he  finds  he  is  able  to  fully  react  from  the  depression  produced 
by  venturing  among  its  lower  depths. 

Time  for  Cold  Bathing — It  is  recommended  by  some  authors  to  resort 
to  cold  bathing  either  about  an  hour  before  breakfast  in  the  early  morning, 
or  else  late  in  the  evening  just  before  retiring  for  the  night.  The  early 
morning  bath  of  this  kind  may  do  very  well  for  some  few  people  of  un- 


HYGIENIC  USE  OF  BATHS.  171 

usually  vigorous  constitutions,  but  as  a  general  rule  tlie  evening  is  a  better 
time  for  such  a  test  of  strength ;  and  for  many  persons  the  middle  of  the 
morning,  that  is  to  say,  about  three  hours  after  breakfast,  when  the  first 
meal  of  the  day  has  been  nearly  all  digested,  and  the  system  is  fortified 
thereby  to  bear  the  shock  and  establish  the  necessary  reaction  after  it, 
is  decidedly  preferable  to  any  other  period  of  the  twenty-four  hours. 

When  to  Avoid  Cold  Baths — Under  no  circumstances  should  a  cold 
bath  be  indulged  in  either  immediately  before  or  immediately  after  a 
meal,  on  account  of  the  tendency  which  its  inevitable  shock  will  have  to 
produce  more  or  less  disturbance  in  the  process  of  digestion  by  congesting 
the  stomach  and  intestines.  ISTor  are  cold  baths  suitable  for  individuals  in 
either  extreme  of  life,  because  both  in  infancy  and  in  old  age  the  power 
of  developing  animal  heat  is  least  efficient  in  its  operations,  and  the 
reaction  is  accomplished  slowly  or  not  at  all. 

No  Cold  Bath  After  Fatigue. — Protracted  labor  or  exercise,  whether 
mental  or  physical,  if  so  long  continued  as  to  leave  the  body  suffering  from 
feelings  of  great  weariness  or  exhaustion,  absolutely  forbid  the  use  of  the 
cold  bath.  It  was  under  these  circumstances  that  Alexander  the  Great, 
of  Macedon,  nearly  perished,  from  plunging  after  a  long  and-  fatiguing 
march  into  the  icy  current  of  the  river  Cydnus ;  an  impi-udence  which, 
it  is  said,  did  actually  prove  fatal  to  the  German  emperor,  the  aged  Fred- 
erick Barbarossa,  at  the  head  of  his  crusading  army,  seventeen  hundred 
years  later.  In  adverting  to  this  latter  event  an  ancient  author  quaintly 
observes:  "Xo  wonder  if  the  cold  water  quickly  quenched  those  few  sparks 
of  heat  left  in  him  at  seventy  years  of  age." 

Duration  of  the  Cold  Bath — The  duration  of  a  cool  or  cold  bath  must 
vary  very  much  with  the  temperature  of  the  water.  When  very  cold  the 
period  of  immersion  should  not  exceed  one  or  two  minutes,  whilst  vpith 
water  between  60  and  70  degrees,  the  duration  of  the  bath  may  extend 
to  a  quarter  or  even  half  an  hour;  in  every  instance,  however,  we  must 
be  guided  by  the  completeness  of  the  reaction  on  coming  out  of  the  water. 

Friction  After  Cold  Bath — Energetic  friction  of  the  whole  surface 
of  the  body  after  bathing  is  highly  beneficial  as  tending  to  produce  the 
necessary  degree  of  reaction.  Active  physical  exercise,  as  well  as  warm 
and  stimulating  drinks,  likewise  aid  in  aecomplisliing  the  same  desirable 
result.  Even  when  a  person  is  accustomed  to  the  daily  use  of  the  cold 
bath,  any  sudden  reduction  of  strength,  such  as  may  result  from  intem^ 
perance  in  eating,  an  evening  debauch,  or  excess  of  any  kind,  particularly 


172  WATEK  IN  ITS   HYGIENIC  BELATIONS. 

of  tho  sexual  powers,  or  even  over-exertion  in  walking  or  in  field-sports, 
wiU  forbid  recourse  to  it  the  following  morning. 

Kiver-Bathing. — Bathing  in  rivers  is  even  more  to  be  reconunended 
than  that  in  ordinary  bath-rooms  during  the  summer  season,  as  the  gentle 
exercise  of  walking  to  and  from  the  river-side,  and  if  swimming  whilst 
immersed  in  the  water,  promote  the  reaction  which  is  so  conducive  to 
health.  Evil  consequences  are,  however,  apt  to  result  from  river-bathing, 
if  the  baths  are  too  prolonged,  if  too  violent  exertion  is  indulged  in,  or  if 
the  rays  of  the  sun  overheat  the  head  of  the  bather.  Dr.  Bell  states  that 
he  has  seen  continued  fever,  of  some  days'  duration,  and  violent  headache, 
with  slight  delirium,  arise  in  boys  who  had  thus  imprudently  exposed 
themselves. 

VARIETIES  or  COLD  BATHS, 

Cold  Sponge-Bath. — There  are  various  ways  of  employing  water  in 
cold  bathing,  according  to  tho  force  of  the  current  of  fluid,  tlie  amount 
of  surface  to  which  it  is  apjilied,  and  so  fortL  Affusion  and  sponging  are 
the  mildest  ways  of  using  cold  water  as  a  bath,  and  there  are  few  persons, 
not  actually  invalids,  who  cannot  thus  employ  water,  of  moderately  low 
temperature,  with  benefit.  After  the  slight  depression  of  the  bodily 
warmth,  produced  by  sponging  with  fluid  of  60  or  65  degrees,  of  course 
but  a  mild  reaction  follows,  but  this  is  suitably  proportioned  to  the  feeble 
energies  of  debilitated  persons.  By  a  repetition  of  the  process  a  greater 
endurance  is  developed,  and  colder  water  may  ultimately  be  resorted  to, 
with  correspondingly  increased  advantage.  The  cool  or  cold  sponge-bath 
is  sometimes  of  great  service  in  treating  typhoid  fever,  and  others  of  the 
eruptive  diseases,  as  will  be  explained  in  the  second  part  of  this  work. 

The  Shower-Bath — In  a  shower-bath  the  water  falls  in  divided 
streams,  and  thus,  being  generally  distributed  over  the  whole  body,  gives 
a  severe  shock  to  the  system ;  such  a  one,  should  the  fluid  be  of  a  low  tem- 
perature, as  only  the  most  vigorous  persons  can  endure. 

The  Cold  Douche. — The  cold  douche  differs  from  the  shower-bath  in 
that  the  water  of  a  douche  is  poured  upon  the  surface  of  the  body  in  a 
solid  column,  instead  of  a  number  of  small  streams.  It  is  sometimes 
highly  eSicacious  in  reducing  the  violent  excitement  of  delirious  or  insane 
patients,  but,  being  a  very  powerful  agent,  should  be  used  only  vsdth  cau- 
tion and  close  watching,  never  in  the  indiscriminate  way  customary  in 
some  so-called  hydropathic  establishments,  from  which  it  is  said  that  more 
than  one  sudden  death  has  been  the  lamentable  result. 


COLD   BATHING. 


173 


The  Bath  for  Old  Age. — The  advance  into  old  age  of  those  who,  in 
the  vigor  o£  youth  and  maturity,  have  accustomed  themselves  to  the  regu- 
lar use  of  the  cold  bath,  does  not  necessarily  interpose  an  obstacle  to  the 
continuance  of  the  practice  of  bathing,  provided  the  general  health  re- 
mains good.  But  if  there  be  evidence  of  feebleness  of  the  functions,  or 
disorder  in  any  one  of  the  great  systems  of  the  body,  such  as  the  digestive 
apparatus,  or  the  muscular  system,  so  as  to  prevent  the  customary  allow- 
ance of  nutritious  food  or  of  exercise  being  taken,  the  cold  i^lunge  or 
shower-bath  should  be  given  up,  and  simple  washing  with  cold  water, 
followed  by  active  friction,  substituted  in  its  place.  Should  even  this 
prove  rather  too  great  a  shock  for  the  enfeebled  powers  of  life,  as  may  be 
evinced  by  want  of  prompt  reaction  subsequently,  recourse  to  anything 
but  the  tejiid  or  warm  bath  must  be  strictly  prohibited. 

The  Water-Cure. — The  evidence  in  favor  of  gi-eat  benefit  being  de- 
rived in  suitable  cases  from  the  so-called  water-cure,  in  the  numerous 
hydropathic  establishments  of  Europe  and  this  country,  is  very  convinc- 
ing; and,  in  fact,  it  is  probable  that  persons  generally  of  great  mobility  of 
temperament,  who  are  readily  excited  and  readily  depressed,  and  whose 
nervous  system  is  soon  exhausted  by  either  bodily  or  mental  efforts,  will 
often  find  relief  in  the  systematic  use  of  a  moderately  cool  or  cold  bath. 

Objection  to  Hydropathy — The  difficulty  is  with  establishments  of 
this  kind  that,  being  carried  on  as  business  enterprises,  their  proprietors 
are  not  withheld,  by  any  philanthropic  considerations,  from  looking  at 
every  case  which  applies  to  them  with  an  eye  to  business,  and  recommend- 
ing their  particiilar  cure  to  all  possible  patients,  except  where  they  are 
very  sure  that  positive  injury  will  result  from  the  treatment.  It  is  there- 
fore advisable,  in  every  instance,  to  consult  some  reputable  physician,  who 
is  not  devoted  to  any  exclusive  system  or  dogma  of  medical  practice, 
before  submitting  oneself  to  the  powerful  agencies  of  water  as  applied  by 
hydropathic   practitioners. 

Cold  Bathing  Removes  Heat. — Dr.  Bell  judiciously  remarks  that  there 
is  a  class  of  iK-oi^lc,  who  suffer  from  a  sedentary  life,  devotion  to  the  desk 
in  business,  or  to  study,  and  complain  of  troublesome  heat  and  dryness 
of  the  hands,  and  sometimes  of  the  feet,  with  accelerated  pulse  and  thirst ; 
their  appetite  is  not  good,  nor  their  sleep  sound  or  refreshing.  Though 
their  systems  be  actually  weaker  than  usual,  yet  is  there  morbid  activity 
of  the  skiu,  owing,  in  pni-t,  to  the  vessels  of  the  integument  not  relieving 
themselves  by  free  and  regular  perspiration.  Cold  bathing,  by  mod- 
erating cutaneous  excitement,  and  relieviug  tlie  perspiratory  organs,  re- 


174:  WATEE  IN  ITS  HYGIENIC  KELATIONS. 

moves  the  unpleasant  feeling  of  heat  and  dryness ;  and,  Ly  sympathy,  pro- 
duces noarlv  corrcs]iondent  effects  on  the  stomach. 

The  Flesh-Brush  and  Exercise — The  use  of  the  flesh-brush  and  exer- 
cise in  the  open  air  are,  it  may  he  supposed,  powerful  auxiliaries  to  the 
measures  just  rccoiumcndcd. 

Cold  Bathing  for  Eheumatism. — There  are  many  persons  who,  tliough 
enjoying  what  is  often  called  full  health,  are  liable  to  colds,  rheumatic 
pains  and  stitches  from  any  slight  exposure  to  cold  or  moist  air.  Their 
vascular  and  nervous  systems  are  both  tolerably  excitable,  and  they  are 
readily  thrown  into  perspiration  from  even  moderate  exercise  or  warm 
apartments.  In  them  it  is  desirable  so  far  to  regulate  the  functions  of  the 
skin  as  to  moderate  its  stimulation,  and  prevent  the  consequent  debility 
which  follows  this  state.  Cold  bathing  accomplishes  this  purpose,  and 
keeps  the  skin  in  a  less  constant  condition  of  excitement,  renders  it  less 
liable  to  sweat  so  freely  from  exposure  to  external  warmth  or  by  active 
exercise,  and,  of  course,  prevents  the  subsequent  languor  and  suscepti- 
bility to  morbid  and  enfeebling  agencies.  It  would  be  a  great  mistake, 
in  such  a  case,  to  talk  of  the  tonic  action  of  cold  bathing.  Its  beneficial 
operation  is  evinced  here  at  a  time  when  no  stimulus  or  tonic  is  admissible, 
and  in  habits  sanguine  and  plethoric,  on  which  nearly  similar  effects  with 
those  from  cold  bathing  would  be  produced  by  a  moderate  bleeding,  re- 
duction of  the  usual  quantity  of  food  and  diluent  drinks. 

HYGIENIC  APPnCATION  OF  WAUM  BATHS. 

Temperature  of  Warm  Bath — When  the  water  used  for  bathing  has 
a  temperature  of  from  92  degrees  to  98  degi'ees  Fahrenheit,  it  produces 
upon  the  skins  of  most  people  the  sensation  of  warmth,  and  although  water 
of  this  degree  of  heat  is  usually  employed  chiefly  for  cleansing  purposes, 
yet  it  has  hygienic  properties  of  a  sufficiently  marked  character  to  render 
it  worthy  of  especial  notice.  Since  water  is  a  much  better  conductor  of 
heat  than  air,  and  esjiceially  than  confined  air,  as  much  caloric  is  extracted 
from  the  human  body  when  immersed  in  water  which  is  only  a  few  degrees 
lower  than  the  average  human  temperature,  as  by  air  of  much  greater 
relative  coldness. 

Effect  of  Warm  Bath — The  warm  bath  diminishes  the  frequency  of 
llie  pulse,  especially  when  it  has  been  greater  than  natural,  and  this  effect 
is  almost  exactly  in  proportion  to  the  duration  of  immersion.  It  also 
renders  the  respiration  slower,  and  diminishes  the  temperature  of  the 


THE  •WATEK-CUEE.  175 

body,  relaxes  the  muscular  fibre,  increases  the  bulk  of  the  fluids  by  absorp- 
tiou,  or  perhaps  only  by  restricting  evaporation  from  the  skin,  removes 
impurities  from  the  surface,  promotes  desquamation  and  renewal  of  the 
cuticle,  lessening  the  hardness  of  the  nails  and  indurations  of  the  epi- 
dermis. 

Separation  of  Outer  Skin — The  separation  of  the  outer  layers  of  the 
scarf-skin  or  epidermis,  -which  may  often  be  seen  floating  in  small,  -whitish 
fragments  upon  the  bath  -water,  is  due  to  t-wo  causes.  In  the  first  place, 
it  is  softened  by  the  water,  and  so  rendered  more  easily  removable  by 
slight  friction;  and  secondly,  it  is  in  jjart  pushed  off  by  the  increased 
fullness  of  the  blood-vessels  underneath.  A  humorous  -writer  has  com- 
pared the  epidermis  which  covers  the  "whole  surface  of  the  body  to  a  tight 
shirt,  and  a  dirty  cuticle,  therefore,  to  a  dirty  shirt  which  is  gotten  rid  of 
by  the  aid  of  a  bath. 

Take  Short  Warm  Baths. — A  prolonged  daily  use  of  the  warm  bath 
is  apt  to  cause  erujjtions  on  the  skin  similar  to  those  which  managers  of 
-water-cure  establishments  pronoimce  critical,  and  of  the  greatest  advan- 
tage in  certain  diseases  of  the  nervous  system. 

Warm  Baths  Soothe  the  Nerves. — An  immediate  and  very  agreeable 
effect  of  the  warm  bath  is  to  soothe  a  nervously  excited  condition  and 
promote  sleep,  -which  to  many  people  is  peculiarly  refreshing  -when  pro- 
cured by  this  means. 

Time  to  Take  Warm  Baths. — The  best  period  for  taking  a  warm  bath 
is  about  an  hour  previous  to  the  mid-day  meal,  because  then  the  disturb- 
ance of  the  circulation  will  have  time  to  pass  off  before  food  is  introduced 
into  the  stomach,  and  the  secretion  of  the  gastric  juice  and  other  fluids 
necessary  for  digestion  -will  not  be  thereby  interfered  -with. 

Duration  of  Warm  Baths — The  duration  of  a  -warm  bath  ought  not 
to  exceed  in  ordinary  cases  half  an  hour,  although  in  the  -warm  -water-cure 
of  Leuk,  in  Switzerland,  patients  sometimes  remain  in  the  tepid  fluid  five 
hours  in  the  morning  and  three  hours  in  the  afternoon,  with  alleged  bene- 
fit. In  the  Leuk  bath,  persons  breakfast  from  little  floating  tables,  -which 
afterwards  serve  to  support  books  and  newspapers  for  their  amusement, 
and  it  is  said  that  the  Emperor  Charlemange  used  to  hold  prolonged  levees 
■whilst  immersed  in  his  -warm  bath  at  Aix-la-Chapelle,  -which  was  supplied 
by  one  of  the  numerous  thermal  springs  of  that  famous  city. 

Warm  Baths  in  Acute  Diseases. — The  relaxing  and  soothing  influence 
of  the  warm  bath  is  an  invaluable  aid  to  the  treatment  of  many  acute 
diseases,  and  being,  as  a  general  rule,  devoid  of  danger  in  its  application. 


176  WATEK  IN  ITS   IIYOIENIC   RELATIONS. 

is  a  rcmetly  peculiarly  adapted  to  domestic  practice,  particularly  among 
cliildreii,  before  the  skilled  physician,  who  should  always  be  sent  for  im- 
mediately when  a  person  it  attacked  with  any  acute  disease,  has  time  to 
arrive.  Its  prompt  remedial  effects  may  often  be  observed  in  bilious 
colic,  in  painter's  colic  induced  by  the  poisonous  influence  of  lead,  in  spas- 
modic croup,  in  infantile  convulsions,  in  mental  excitement  bordering  on 
delirium  or  even  violent  maniacal  frenzy,  and  in  many  other  diseases,  as 
will  be  more  fully  explained  in  the  second  part  of  this  book. 

HOT  BATHS. 

Temperature  of  the  Hot  Bath. — The  hot  bath  is  so  designated  if  the 
water  employed  is  above  the  natural  blood-heat  of  about  98  degrees 
Fahrenheit,  and  may  range  as  high  as  110  degrees,  above  which  it  is 
seldom  safe  to  use  water  over  the  whole  surface  of  the  body.  Of  course, 
habit  will  often  enable  a  person  to  endure  the  local  application  of  water 
having  a  much  higher  temperature  than  this  without  injury. 

Effect  of  Hot  Baths — Hot  baths  are  decidedly  stimulating,  and  rap- 
idly jiroduce  redness  of  the  skin  with  quickening  of  the  pulse  and  respira- 
tion. Perspiration  is  poured  out  upon  the  face  in  great  abundance,  the 
mind  becomes  dull  and  inattentive,  and,  if  the  immersion  is  unduly  pro- 
longed, vertigo  and  apoplexy  may  sujiervcne.  One  experimenter  lost,  dur- 
ing the  short  space  of  eight  minutes,  in  a  bath  of  the  temperature  of 
113  degrees,  about  a  pound  and  a  half  of  his  weight.  Even  a  hot  foot- 
bath of  110  degrees  is  stated  in  one  case  to  have  quickened  the  pulse  from 
seventy-seven  to  ninety-two,  and  to  have  caused  some  headache  in  about 
half  an  hour.  In  another  instance  a  foot-bath  of  113  degrees  raised  the 
pulse  from  sixty  to  one  hundred  and  five  beats  per  miniite  in  five  minutes, 
and  flushed  the  face,  but  without  bringing  on  headache. 

Where  Danger  Lies. — The  hot  bath  ought  therefore  to  be  employed 
cautiously  or  not  at  all  by  persons  of  sanguine  temperament,  and  those  of 
robust  or  plethoric  habit  of  body,  especially  if  there  is  any  hereditary 
tendency  to  apoplexy  in  their  families. 

Where  Good  is  Derived — This  powerful  remedy  is,  however,  capable 
of  doing  good  service  in  conditions  of  torpid,  sluggish  circulation,  dry  and 
cold  .skin,  feebleness  of  muscular  movement,  and  a  low  grade  of  sensi- 
bility; but  great  care  must  be  used  not  to  mistake  this  state  of  the  system 
in  an  individual  naturally  weak  and  phlegmatic,  or  enfeebled  by  old  age 
or  chronic  disease,  for  the  languor  of  the  vital  processes  which  is  pro- 


HOT   BATHS.      .  177, 

duced  by  acute  inflammation,  or  pressure  of  the  blood  upon  tlic  brain 
or  upon  tlie  lungs. 

When  to  Avoid  Hot  Baths. — In  suspended  animation  from  sunstroke, 
apoplexy,  insensibility  from  inhaling  noxious  gases,  or  from  swallowing 
narcotic  jjoisons,  disastrous  results  might  be,  and  probably  would  be,  pro- 
duced by  the  application  of  a  hot  bath. 

When  to  TJse  Hot  Baths — In  exhaustion  and  torpor  from  exposure  to 
intense  cold,  the  hot  bath,  contrary  to  popular  opinion  on  the  sub-ject,  is 
a  most  valuable  remedy.  Some  recent  experiments  performed  in  Kussia, 
in  order  to  determine  what  is  the  best  way  to  resuscitate  animals  which 
have  been  subjected  to  such  severe  cold  as  to  be  almost  fatal  in  its  effects, 
gave  the  following  results:  Of  twenty  dogs  treated  by  the  customary 
gradual  method  of  bringing  them  into  a  cold  room  which  was  slowly 
warmed,  fourteen  died ;  of  twenty  similar  animals  introduced  at  once 
into  a  warm  room,  only  eight  died ;  whilst  of  twenty  in  an  analogous  con- 
dition, which  were  placed  at  once  in  a  hot  bath,  all  recovered. 

local  Hot  Baths — Hot  baths  applied  locally  to  small  portions  of  the 
body  only,  have  often  proved  beneficial  in  gout  and  in  acute  as  well  as 
chronic  rheumatism,  and  are  highly  recommended  by  some  authorities  for 
the  relief  of  piles,  in  certain  affections  of  the  kidneys,  and  in  some  female 
disorders.  Sundry  modifications  of  the  liot  bath,  such  as  the  Turkish 
bath,  the  vapor  bath,  and  so  forth,  have,  under  certain  circumstances,  con- 
siderable value. 

THE  HYGIENE  OF  SEA-BATHING. 

When  to  Refrain  from  Sea-Bathing — The  long  line  of  seacoast  belong- 
ing to  the  United  States,  and  the  large  proportion  of  oiir  popiilation  which 
resides  within  a  day's  journey  of  the  ocean,  by  placing  a  salt  bath  within 
the  reach  of  many  readers,  render  the  subject  of  sufficient  importance 
to  be  separately  discussed.  On  paying  a  visit  to  the  seaside,  it  is  well  to 
refrain  from  bathing,  and  indeed  from  exposure  to  the  rays  of  the  sun 
on  dry  land  also,  for  a  day  or  two  if  possible  after  arrival,  or  until  the 
system  becomes  a  little  accustomed  to  the  effect  of  the  salt  air  and  the 
surroundings.  The  rules  already  given  in  regard  to  the  time  of  bathing, 
and  especially  as  to  not  entering  the  water  for  an  hour  or  so  before  or 
after  a  meal,  ought  to  be  strictly  adhered  to. 

Duration  of  Sea-Baths — The  time  spent  in  the  water  cannot  be  pre- 
scribed with  the  same  exactitude,  since  the  proper  length  of  a  dip  in  the 
ocean  varies  very  greatly  with  the  temperature  of  the  water  and  air,  the 
12 


178  WATKE  IIT  ITS   IITGrETfIC  EEI.ATIONS. 

vi"-or  of  tbe  individual's  constitution,  Lis  temporary  condition  of  health, 
and  so  forth.  But  in  the  state  of  the  circulation  "we  fortunately  have  a 
general  guide,  which  every  one  can  readily  consult  for  himself,  and  quickly 
determine  vehen  nature  decides  that  the  bath  should  promptly  terminate. 
After  the  first  shuddering  inspiration,  which  is  generally  produced  by  the 
application  of  cold  water  to  the  bare  surface  of  the  body,  with  the  quick- 
ened pTilse  and  breathing  which  for  a  few  moments  accompany  it,  the 
pulse,  the  action  of  the  heart,  and  the  respiration  all  become  slower  for  a 
short  time,  and  then  are  again  accelerated. 

Signs  to  Stop  a  Sea-Bath — But  if  immersion  in  the  cold  sea-water  is 
too  long  contiuiied,  the  pulse  and  the  breathing  are  again  reduced  in 
frequency,  a  sense  of  chilliness  comes  on,  and  vrith  this  a  slight  blueness 
of  the  lips,  and  of  the  fingers  underneath  the  nails,  makes  its  appearance. 
The  moment  this  is  perceived  it  should  be  accepted  as  an  imperative  order 
to  quit  the  water  at  once  and  restore  the  lost  activity  of  the  circulation, 
which  it  indicates,  by  energetic  friction  of  the  surface  with  warm,  dry 
towels  as  speedily  as  possible.  As  a  general  rule,  from  five  to  fifteen 
minutes  is  amply  sufficient  time  to  spend  in  the  surf,  and  it  is  far  better 
to  err  on  the  prudent  side  by  coming  out  needlessly  soon,  than  to  prolong 
the  bath  until  the  teeth  begin  to  chatter  and  the  fingers  have  the  shriv- 
elled, bluish-white  appearance  of  a  washerwoman's  hand,  thereby  risking 
some  serious  internal  congestion  afterwards.  When  the  water  is  unusually 
cold,  and  especially  when  the  air  is  also  chilly,  a  bath  in  the  ocean,  if 
taken  at  all,  should  be  correspondingly  brief. 

What  Sea-Bathers  Should  Do — In  order  to  obtain  the  best  results,  a 
bather  should  outer  the  water  whilst  he  is  comfortably  warm,  and  yet 
not  in  a  free  state  of  perspiration.  It  is  a  good  plan  to  wet  the  head  and 
breast  first,  or  after  wading  only  a  short  distance  from  the  edge,  for  the 
purpose  of  avoiding  the  temporary  fullness  of  the  brain,  which  leaves 
some  persons  with  a  dull  licadache  for  several  hours ;  also,  if  the  sun  is 
shining  brightly,  a  bathing  hat,  or  other  protection  for  the  head  and  nape 
of  the  neck,  ought  always  to  be  worn. 

Adjuncts  of  Sea-Bathing — Floating,  diving  and  swimming  are  ex- 
cellent ways  of  adding  to  the  pleasure  of  the  sea-bath,  but  the  latter  should 
not  be  indulged  in  when  the  surf  is  very  heavy,  when  the  tide  is  running 
out,  or  when  tbere  is  a  strong  current  nearly  in  a  line  with  the  margin  of 
the  beach,  as  the  latter  may  diverge  a  little  from  the  coast,  and  carry  the 
bather  too  far  out  to  sea  before  he  is  aware  of  his  danger. 


INDEX  TO  PART  III  OF  BOOK  III 

Preventive  Medicine 
Pure  Air  Necessary  for  Health 

Part  III  of  Book  III  deals  with  effects  of  air 
upon  health  and  shows  the  necessity  of  taking  every 
possible  precaution  to  secure  pure  air  in  the  home. 

SUBJECTS  OF  THE  TEXT 


Air,  Action  of  Impurities  of i86 

Air,  Bacteria  in 187 

Air   a   Blood    Purifier 181 

Air  Changes,  Frequency  of 196,   197 

Air,  Composition  of  Pure  Air 182 

Air  and  Consumption 198 

Air,  Contamination  by  Sewer-Gases,    198 
Air,  Fatal  Results  from  Impure  Air,  181 

Air,   Impurities   of 186 

Air,  Localities  of  Pure  Air 183 

Air,  Necessity  of  Pure  Air i8r 

Air  Poisoning   186,  187 

Air,  Qualities  of  Pure  Air 182 

Air,  Quantity  for  a  Room 195 

Air,   Residual   185 

Airs,  Relative  Weight  of 196 

Anatomy  of  the  Respiratory  Tract. . . .  183 

Apartments,  Size  of I95 

Asthma,    Grinders'    201 

Bacteria  in  the  Air 187 

Blood  Purifier,  Air  as 181 

Breathing,  Frequency  of l8s 

Change  of  Air,  Necessity  of  Frequent 

Change    196,  197 

Clothing    187 

Coal  Dust  as  a  Cause  of  Consumption,  200 

Cold  Air  187 

Composition  of   Pure   Air 182 

Consumption  and   Air 198 

Consumption,  Coal  Dust  as  a  Cause  of,  200 

Consumption,    Saw-Grinders'    201 

Contamination  of  Air  by  Sewer-Gases,  igS 

Danger  of  Saliva-Loaded  Dust 200 

Dangers  of  Neglected  Ventilation. ..  .198 
Dangers   from   Wet-Grinding 202 


Diphtheria  from  Sewer-Gas 199 

Diseases,   Match-Makers'    203 

Dust- 
As  a  Cause  of  Disease 2co 

Coal  Dust  as  a  Cause  of  Consump- 
tion  200 

Danger  of  Saliva-Loaded  Dust 200 

Fume   Poison    203 

Grinders'  Asthma   201 

Magnetic   Plate,   The 203 

Match-Makers'  Diseases   203 

Mechanical  Fan,  The 202 

Metal   Fumes    203 

Pottery  Dust  202 

Saw-Grinders'   Consumption    201 

Tobacco  Dust  203 

Wall-Paper  Poisons  203 

Wet-Grinding,  Dangers  from 202 

White-Lead   Poison    203 

Effects   of   Temperature 197 

Examples  of  Sewer-Gas  Poison 199 

Fan,  Mechanical,  for  Dust 202 

Fatal  Results  from  Impure  Air 181 

Frequency  of  Air  Changes ig6,  197 

Fumes,  Metal  203 

Fume  Poison    203 

Gas   Poison,   Examples   of   Sewer-Gas 

Poison  199 

Grinders'  Asthma  201 

Grinders'   Consumption    201 

Health,  Influence  of  Winds  on  Health,  192 
Heart    Function    in    the    Respiratory 

Tract   184 

Importance  of  Ozone 194 

Importance  of  Ventilation 194 


179 


180 


INPEX  TO  PART  III  OF  BOOK  III. 


Impure  Air,  Fatal  Results  from i8i 

Impurities  of  Air i86 

Impurities  of  Air,  Action  of i86 

Influence  of  Winds  on  Health 192 

Larynx,  The   183 

Localities  of  Pure  Air 183 

Lungs,    The    183 

Magnetic  Plate  for  Metal  Dust 202 

Match-Makers'  Diseases  203 

Mechanical  Fan  for  Dust 202 

Metal  Dust,  Magnetic  Plate  for 202 

Metal   Fumes    202 

Natural  Ventilation   196 

Necessity  of  Pure  Air   181 

Neglected  Ventilation,  Dangers  of 198 

Origin  of  Ozone 194 

Ozone — 

Importance  of 194 

In  Pine  Woods 194 

Origin  of  194 

Property  of  Turpentine 194 

Physiology  of  the  Respiratory  Tract,  184 

Pine  Woods,  Ozone  in 194 

Plate,  Magnetic,  for  Metal  Dust 202 

Poison,      Examples      of      Sewer-Gas 

Poison  199 

Poison,  Fume  203 

Poison  from  Sewer-Gas 199 

Poison,  White-Lead  203 

Poisoning,  Air  186,  187 

Poisons  in  Sewer-Gas 199 

Poisons,  Wall-Paper    203 

Pottery   Dust    202 

Process,  Hardening   188 

Property  of  Turpentine 194 

Providing  Against  Weather 189 

Pure  Air,  Composition  of 182 

Pure  Air,  Locality  of 183 

Pure  Air,  Qualities  of 182 

Quantity'  of  Air  for  a  Room 195 

Relative  Weight  of  Airs 196 

Residual    Air    185 

Respiration    185 

Respiratory  Tract — 

Anatomy  of  183 

Heart  Functions   184 

Larynx,   The    183 


Lungs,  The   183 

Physiology    of    184 

Trachea,  The   183 

Room,  Quantity  of  Air  for 195 

Room,    Sleeping    196 

Saliva-Loaded  Dust,  Danger  from.... 200 

Saw-Grinders'    Consumption    201 

Sewer-Gas — 

Avoiding   Poison   from zoo 

Contamination  of  Air  by 198 

Diphtheria  from  199 

Examples  of  Sewer-Gas  Poisoning,  199 

Poisons    in    199 

Proof  of  Poisons   in igp 

Typhoid  from  199 

Vomiting  from  199 

Size  of  Apartments 195 

Sleeping  Room,  The 196,  197 

Ventilation  in 197 

System  of  Ventilation 194 

Temperature,  Effects  of  197 

Trachea,  The   183 

Tract,    Respiratory.     See   Respiratory 
Tract. 

Turpentine,  Property  of 194 

Typhoid    from    Sewer-Gas 199 

Ventilation — 

Dangers  of  Neglected  Ventilation,   198 

Effects   of  Temperature 197 

Frequency  of  Air  Changes 196,  197 

Importance   of    194 

In  Sleeping  Rooms 197 

Natural  Ventilation    196 

Quantity  of  Air  for  a  Room 19S 

Size  of  Apartments 195 

Sleeping    Room,    The 196 

System  of   194 

Weight  of  Airs 196 

Vomiting  from  Sewer-Gas 199 

Wall-Paper  Poisons  203 

Weather  Observations   189 

Weather,  Providing  Against 189 

Weight  of  Airs,  Relative 196 

Wet-Grinding,  Dangers  from 202 

White-Lead  Poison  203 

Winds,  Influence  on  Health 192 


Lungs,  The 


UST  OF  ILLUSTRATIONS 

183  I  Lungs,  Air  Passages  of. 


.184 


PREVENTIVE   MEDICINE 


PART  III. 
PURE  AIR  NECESSARY  FOR  HEALTH 


THE  VITAL  NECESSITY  OF  AIE. 

Value  of  Pure  Air — There  are  some  things  in  nature  of  which  we 
take  but  little  cognizance,  probably  from  the  fact  of  their  apjiarent  sim- 
plicity. Pure  air,  pure  water,  pure  food  are  essential  and  fundamental  to 
good  health  and  health  to  happiness,  so  we  see  that  our  very  lives  depend 
upon  the  exercise  of  principles  which  we  neglect  to  study  and  understand, 
possibly  on  accoimt  of  other  and  manifold  duties.  But  natnre's  laws  are 
invariable,  and  the  time  comes  when  dire  results  follow  a  disregard  of 
first  principles.  Any  one  wiU  admit  that  pure,  unadulterated  food  is 
necessary  to  health.  Pood  is  converted  into  blood,  which  having  circu- 
lated through  the  body  is  unfit  for  further  use  until  purified. 

Air  a  Blood  Purifier. — It  is  through  the  medium  of  the  air,  with  its 
life-giving  oxygen,  that  the  blood  is  purified.  It  therefore  follows,  logic- 
ally, that  air  and  pure  air  is  necessary  to  health  and,  other  things  being 
equal,  the  health  will  be  imperfect  in  proportion  to  the  impurity  of  the 
air  we  breathe.  It  should  be  our  aim  to  learn  much  of  so  important  a  con- 
dition of  health  in  order  that  we  might,  so  far  as  is  possible,  avoid  disease. 

Necessity  of  Pure  Air. — Not  only  is  pure  air  of  value  to  preserve  a 
state  of  health,  it  is  an  absolute  necessity.  It  is  true  that  some  persons 
with  strong  wills  and  capacious  lungs  can  perform  the  feat  of  holding  the 
breath,  but  if  they  endeavor  to  prolong  the  experiment  from  a  minute 
and  a  half  to  two  minutes  the  need  of  breathing  becomes  so  intense  that 
control  over  the  muscles  of  the  chest  is  lost  and  a  deep  inspiration  must 
be  drawn  in  spite  of  resolutions  to  the  contrary.  If  the  access  of  fresh 
air  to  the  lungs  is  absolutely  prevented  by  external  force  death  speedily 
takes  place,  the  fatal  result  occurring  in  from  five  to  fifteen  minutes. 
This  latter  condition  is  present  in  hanging  and  drowning  and  in  some 
forms  of  croup  in  children.  Pour  minutes  Is  the  limit  of  time  a  person 
can  be  deprived  of  oxygen  and  live. 

Fatal  Results  from  Impure  Air — IvTo  better  illustration  of  the  fatal 
effects  of  impure  air  upon  the  human  svstem  can  be  brought  forward  than 

(181) 


182  PTTEE  AIR  AS    A   CONDITION   OF   HEALTH. 

the  lamentable  history  of  the  Black  Ilole  of  Calcutta,  a  prison  in  India, 
the  horrors  of  which  have  rendered  it  memorable  even  in  that  land  of 
ferocious  cruelty.  According  to  the  accoimt  of  a  survivor,  146  persons 
were  shut  up  on  a  sultry  night  in  June  in  a  prison  eighteen  feet  square, 
furnished  with  only  two  small  windows,  both  strongly  barred  with  iron. 
The  thirst  and  oppression  of  breathing  felt  by  the  unhappy  prisoners  soon 
became  intense,  and  the  scanty  supply  of  water  brought  in  compliance 
with  their  entreaties  only  made  the  confusion  more  terrible,  and  caused 
several  to  be  trampled  to  death.  This  scene  of  misery  proved  entertain- 
ing to  the  brutal  guards  outside,  who  supplied  them  with  water  that  they 
might  have  the  satisfaction  of  seeing  them  fight  for  it,  as  they  phrased  it, 
and  held  up  lights  to  the  bars  in  order  that  they  might  lose  no  part  of  the 
inhuman  diversion. 

Frantic  Pleas  for  Air — ^Before  eleven  o'clock  most  of  the  gentlemen, 
who  formed  about  one-third  of  the  whole,  were  dead,  and  "air!  air!"  be- 
came the  general  cry.  Renewed  insults  were  devised  for  the  purpose  of 
provoking  the  guards  to  shoot  them,  and  every  man  had  eager  hopes  of 
meeting  the  first  bullSt.  About  two  o'clock  in  the  morning  the  survivors 
crowded  so  much  to  the  windows  that  many  of  them  died  standing,  unable 
to  fall  on  account  of  the  throng.  About  six  in  the  morning  an  order  came 
for  their  release ;  but  at  that  time,  out  of  the  146  who  went  into  the  dun- 
geon ten  hours  before,  only  23  remained  alive,  and  all  these  miserable 
survivors  were  in  a  highly  feverish  condition,  several  dying  from  putrid 
or  typhus  fever  soon  afterward. 

We  Breathe  Out  Poison. — Such,  then,  are  the  frightful  consequences 
of  overcrowding  together  a  large  number  of  human  beings,  and  thus 
depriving  them  of  fresh  air  in  such,  a  way  that  they  are  exposed  to  the 
poisons  of  their  own  contamination,  comjjrising  carbonic  acid  and  the 
secretions  from  the  lungs  and  skin.  ^\Tiolesale  poisonings  by  very  impure 
air  of  this  kind  are  fortunately  seldom  met  with,  but  the  gradual  injury 
to  health  and  destruction  of  life-force,  produced  by  breathing  an  atmos- 
phere slightly  contaminated  with  noxious  ingredients,  are  exceedingly 
common,  and  probably  give  rise  to  or  aggravate  a  large  part  of  the  diseases 
to  which  our  flesh  is  heir. 

GUALITIES  or  PURE  AIH. 

Composition. — In  speaking  of  pure  air  we  refer  to  a  standard  con- 
dition of  air.  The  air  is  a  mechanical  mixture  of  elements.  As  ordinarily 
met  with  at  the  surface  of  our  earth,  pure  air,  when  analyzed,  is  found  to 
be  composed  of  seventy-nine  parts  of  nitrogen  and  twenty-one  parts  of 


QUALITIES    OF   PURE    AIR. 


183 


oxygen  to  every  one  hundred  parts  o£  air.  It  contains  also  a  considerable 
quantity  of  watery  vapor,  a  trace  of  ammonia,  and  from  three  to  six  parts 
in  ten  thousand  of  that  deleterious  gas  carbonic  acid.  Oxygen  is  the 
active  element.  If  a  candle  be  held  in  oxygen  it  would  burn  more 
brightly  than  in  ordinary  air,  and  so  our  own  lives,  if  lived  in  an  atmos- 
phere of  oxygen,  would  be  more  quickly  spent.  Our  tissues  would  be 
quickly  used  up.  ISTitrogen,  which  forms  so  large  a  proportion,  acts  simply 
as  a  diluent ;  of  itself  it  cannot  support  life,  and  a  lighted  candle  held  in 
nitrogen  gas  is  quickly  extinguished.  Carbonic  acid  gas,  or,  as  it  is  called, 
carbon  dioxide,  is  normal  to  the  extent  of  .04  per  cent.,  and  though  it  is 
useless  to  animals,  it  is  quite  as  necessary  to  plant  life  as  is  oxygen  to  us. 

Localities  of  Pure  Air. — As  air  is  rendered  impure  by  respiration,  the 
purest  air  is  found  in  those  localities  farthest  removed  from  human, 
habitation,  i.  e.,  on  the  mountain  tops  and  upon  the  ocean.  When  there 
is  a  tendency  to  disease  or  during  recovery  from  a  disease  residence  in 
the  mountains  or  at  the  seashore  is  of  distinct  benefit. 

In  order  to  imderstand  how  it  is  that  the  breathing  in  and  out  of  the 
air  of  a  room  in  time  vitiates  it,  it  will  be  necessary  to  explain  some  points 
of  the  anatomy  and  physiology  of  the  respiratory  tract — and  the  act  of 
respiration. 

RESPIRATORY  TRACT. 

Anatomy. — The  respiratory  tract  is  made  up  of  the  lungs  and  the  air 
passages  leading  to  them.  The  air  passages  comprise  the  larynx  or  voice 
box,  the  trachea  or  windpipe  and  the  bronchial  tubes — two  in  number — 
which  are  branches  of  the  trachea. 

The  Larynx — The  larynx  is  situated  at  the 
upper  part  of  the  trachea  and  presents  in  front 
the  prominence  known  as  Adam's  Apple. 

The  Trachea — The  trachea  or  windpipe  is 
four  and  a  half  inches  long,  and  extends  from 
the  larynx  to  about  the  middle  of  tlie  breast-bone 
or  sternum,  where  it  divides  into  the  two  bron- 
chial tubes. 

The  Lnngs — The  lungs,  two  in  number,  are 
eituJfted  in  the  cavity  of  the  thorax  or  chest,  one 
on  either  side  of  the  heart.  The  lungs  are  made 
up  of  lobes,  and  the  lobes  are  made  up  of  still 
smaller  divisions  called  lobules  or  little  lobes. 
These  latter  are  quite  small,  one  one-hundred 
and  twentieth  of  an  inch  in  diameter,  and  they  The  Lungs. 


184J 


PUEE  AIE  AS  A   CONDITION   OF   HEALTH. 


represent  the  ultimate  divisions  of  the  bronchial  tubes,  which  have  rami- 
fied and  subdivided  like  the  branches  of  a  tree.  Surrounding  each  lung 
and  lining  the  cavity  of  the  chest  is  the  pleura,  an  inflammation  of  which 
constitutes  the  disease  known  as  pleurisy. 

Physiology — The  larynx,  trachea  and  bronchial  tubes  admit  the  air 
to  the  lungs.  The  larynx,  in  addition  to  this  function,  is  the  organ  of 
voice,  being  supplied  with  the  vocal  cords.  Voice  is  produced  by  the  out- 
going air  setting  these  cords  into  vibration.     The  air  cells,  of  which  the 

lungs  are  composed  are  the 
meeting  places  of  the  air  and 
the  blood  for  the  purpose  of  the 
exchange  of  oxygen  and  car- 
bonic acid. 

Heart     Functions The 

heart,  which  is  a  thick,  strong 
muscular  bag,  pumps  the  blood 
through  the  lungs  as  it  goes 
round  and  round  through  the 
circulation,  at  the  rate  of  about 
sixteen  hundred  pints  of  the 
vital  fluid  every  hour.  These 
sixteen  hundred  pints  of  blood, 
by  being  spread  out  in  the  fine 
network  of  delicate  tubes  in  the 
walls  of  the  air-cells,  get  rid  of 
nearly  sixty  pints  of  carbonic 
acid,  and  absorb  rather  more 
than  sixty  pints  of  oxygen  in 
that  length  of  time.  Upon 
this  gaining  of  fresh  oxygen 
and  getting  rid  of  stale  carbonic 
acid  unceasingly,  our  very  lives  depend,  for,  as  demonstrated  in  hanging 
and  drowning,  if  this  interchange  of  the  gases  in  the  blood  is  interrupted 
for  even  the  space  of  a  few  minutes  death  is  the  effect. 

■Unceasing  Heart  Pumping. — Whilst  life  continues,  night  and  day,  our 
hearts  must  go  on  pumping  dark,  purple,  venous  blood  into  the  lungs,  to 
be  there  purified  and  changed  into  red  arterial  blood  by  losing  its  carbonic 
acid  and  gaining  fresh  oxygen,  which  is  carried  to  every  part  of  our  bodies, 
as  has  been  just  explained,  conveying  everywhere  its  own  new  and  vigor- 
ous life.     Night  and  day,  too,  quite  as  unceasingly,  must  the  lungs  do 


The  Air  Passages  of  the  Lungs. 


EESIDTTAI.   AIR.  185 

their  part,  by  piimpiBg  in  fresh  air  to  furnish  this  requisite  supply  of 
revivifying  oxygen;  and,  what  is  almost  equally  important,  they  must 
pump  out  the  air  which  has  been  partly  deprived  of  its  oxygen,  and  has 
received  in  its  x^lace  the  worn-out  and  now  deleterious  substances  got  rid 
of  by  venous  blood.  This  constitutes  the  pulmonary  circulation  in  dis- 
tinction to  the  circulation  of  the  blood  through  various  parts  of  the  body 
for  purposes  of  its  nutrition  which  constitutes  the  systematic  circulation. 

Respiration — The  lungs,  which  contain  the  air,  are  not  active  in  the 
act  of  respiration.  The  chest  cavity  enlarges  by  the  contraction  of  the 
diaphragm  and  the  elevation  of  the  ribs  and  sternum,  so  that  the  chest 
is  enlarged  in  its  vertical,  its  transverse  and  its  antero-posterior  dimen- 
sions. With  this  enlargement  the  pressure  from  without  is  greater  than 
the  pressure  from  within,  and  the  air  rushes  in,  thereby  distending  the  air 
vesicles.  In  expiration  the  chest-cavity  diminishes  in  the  diameters  in 
which  it  has  been  increased,  and,  as  a  result,  the  air  in  the  lungs  is  sub- 
jected to  pressure,  and  consequently  rushes  out.  The  air  that  passes  in 
and  oiit  with  each  respiration  is  called  tidal  air,  and  is  equal  to  twenty 
cubic  inches  of  air.  But,  after  an  ordinary  inhalation,  it  is  possible,  by 
the  exercise  of  a  little  eifort,  to  breathe  in  still  more  air,  to  the  extent  of 
one  hundred  cubic  inches.  This  is  called  the  complemental  air.  After 
an  ordinary  expiration  it  is  still  jjossible  to  breathe  out  air  to  the  ex- 
tent of  one  hundred  cubic  inches.  This  is  called  the  supplemental  or 
reserve  air. 

Residual  Air — After  all  effort  to  expel  air  from  the  lungs  there 
still  remains  about  one  hundred  cubic  inches,  called  the  residual  air,  from 
the  fact  that  it  resides  in  the  lungs.  But  we  must  not  get  the  idea  that 
this  residual  air  is  imchanged,  for  it  is  ever  being  purified. 

Frequency  of  Breathing — The  respirations  vary  from  fourteen  to 
eighteen  per  minute.  They  are  greater  during  infancy  and  childhood.  It 
is  then  during  respiration  that  the  fresh  air,  laden  with  oxygen,  is  carried 
to  the  blood  to  give  to  the  blood  its  oxygen,  and  to  receive  in  its  place 
carbonic  acid.  But  the  air  does  not  meet  the  blood  directly.  On  the 
outer  side  of  the  air  cells  we  have  the  air,  while  distributed  on  its  inner 
side  we  have  the  small  blood-vessels  or  capillaries  which  have  carried  the 
blood  to  the  lungs.  So  that  separating  the  air  from  the  blood  we  have, 
first,  the  walls  of  the  air  cells,  and  second,  the  walls  of  the  capillaries. 
But  these  two  are  so  thin  and  delicate  that  the  exchange  can  readily  take 
place  through  them. 


186  PUKE  AIR  AS  A  CONDITION  OF  HEALTH. 

IMPURE  AIE. 

The  Impurities  of  the  Air. — The  light  of  modern  research  has  enabled 
us  to  know  much  of  atmospheric  conditions  conducive  to  disease  and 
health,  the  latter  particularly  engaging  our  attention  at  this  time.  The 
impurities  of  the  air  are,  first,  suspended  substances  and,  second,  gaseous 
substances.  The  suspended  substances  are  particles  of  almost  every 
known  substance,  the  most  important  being  sand,  dust,  soot,  pollen,  micro- 
organisms of  all  kinds,  particles  of  food  and  clothing.  The  gaseous  im- 
purities are  carbonic  acid,  whenever  it  exceeds  .05  per  cent. ;  carbon 
monoxide;  sulphur  dioxide;  sulphuric,  hydrochloric  and  nitric  acids;  hy- 
drogen sulphide,  ammonia  and  its  compounds,  and  organic  vapors  from 
decomposing  animal  and  vegetable  matters. 

Action  of  Impurities  of  the  Air — The  solid  impurities  act  by  clogging 
up  the  air  vesicles,  thereby  interfering  with  their  function.  They  may 
of  themselves  be  causes  of  disease,  as  in  the  case  of  micro-organisms.  The 
gaseous  impurities  act,  first,  by  virtue  of  their  own  toxic  or  poisonous 
properties  and,  second,  by  the  fact  that  they  take  the  place  of  the  neces- 
sary clement,  oxygen.  Carbonic  acid  is  normal  to  the  extent  of  .04  per 
cent.  As  before  mentioned,  air  that  we  inhale  contains  twenty-one  parts 
of  oxygen  and  seventy-nine  parts  of  nitrogen  to  every  one  hundred  parts 
of  air.  On  the  other  hand,  expired  air  contains  sixteen  parts  of  oxygen, 
five  parts  of  carbonic  acid  and  seventy-nine  parts  of  nitrogen.  If,  now, 
"we  should  be  placed  in  a  room  where  the  air  is  unchanged,  the  air  inhaled 
contains  a  greater  jjercentage  than  .04  per  cent.,  and  is  consequently  im- 
pure. 

Carbonic  Acid — Carbonic  acid  is  the  most  common  impurity  of  air, 
and,  with  its  associated  organic  matters  from  human  or  animal  breathing, 
pollutes  the  atmosphere  of  closed  or  badly-ventilated  apartments  in  the 
manner  already  described.  Acute  poisoning  from  contaminated  air,  such 
as  took  place  in  the  Black  Hole  of  Calcutta,  is  very  uncommon,  because 
people  who  are  long  shut  np  in  over-crowded  rooms  always  feel  such  an 
overpowering  need  of  fresh  air  that  they  can  be  prevented  only  by  main 
force  from  hurrying  away  from  the  danger  to  which  they  are  exposed. 
Nature  warns  them  so  emphatically  and  irajieratively  to  seek  a  purer 
atmosphei-e  that  they  become  ready  to  sacrifice  everything  to  obey  her 
commands. 

Symptoms  of  Air  Poisoning^. — The  early  symptoms  of  oppression  from 
breathing  impure  air  are  too  well  known  to  require  any  lengthened  de- 
scription, although  the  direct  connection  of  many  uncomfortable  sensations 


EFFECTS  OF  EXPOSURE  TO  DRAUGHTS.  187 

experienced  iu  crowded  rooms,  with  the  aerial  contamiuatiorL,  is  not  so 
generally  understood  and  appreciated.  Among  the  primary  indications 
of  physical  injury  to  the  hlood  from  inhaling  vitiated  or  "second-hand"  air, 
are  a  disposition  to  draw  long,  full  breaths,  as  a  result  of  the  stifled  or 
almost  suft'ocated  feeling  which  eai'ly  makes  itself  apparent.  This  is 
accompanied,  or  soon  followed,  by  flushing  of  the  face,  throbbing  of  the 
temples,  headache  and  sickness  at  the  stomach,  which  may  even  proceed 
so  far  as  faintness  or  an  actual  fainting-fit,  as  we  often  see  in  delicate 
ladies  accidentally  wedged  in  crowded  lecture^rooms,  concert-hails  or 
theatres. 

Chronic  Eflfects  of  Air  Poisoning;. — The  chronic  effects  of  long-con- 
tinued breathing  an  air  which  is  but  moderately  polluted  are  seen  in 
a  general  deterioration  of  the  strength,  appetite  and  digestion,  a  pallid 
dyspeptic  appearance,  from  want  of  renewal  of  the  blood. 

Bacteria  in  the  Air. — Bacteriology  has  explained  the  cause  of  many 
diseases.,  The  air  is  everywhere  laden  with  them.  They  enter  our  bodies 
through  the  respiratory  and  digestive  tracts.  If  our  vitality  or  resistance 
is  sufficient  to  withstand  their  invasion  we  remain  in  a  state  of  health ;  but, 
when  the  vitality  is  lowered  for  any  reason,  the  bacteria  invade  the  system 
and  disease  results.  The  bacteria  present  in  the  atmosphere  are  not,  as 
a  ride,  actively  disease  producing.  Those  that  do  produce  disease  are 
found  particularly  where  the  discharges  of  diseased  animals  have  been 
alloAved  to  collect  and  dry.  These  excretions  become  pulverized  and  are 
subsequently  carried  about  in  the  air  we  breathe.  The  dried  expectora- 
tion of  cases  of  tuberculosis,  of  influenza,  and  occasionally  of  pneumonia, 
produce  these  diseases  in  this  manner.  The  boards  of  health  in  various 
parts  of  the  country  are  fast  coming  to  the  conclusion  that  expectoration 
upon  the  sidewalks,  in  the  street  cars,  in  public  halls,  and  so  forth,  is  a 
menace  to  the  public  well-being.  In  hospitals  patients  suffering  with 
tuhercidous  disease  are  obliged  to  expectorate  in  special  cups  or  paste- 
board boxes,  which  are  kept  covered  aiul  subsequently  destroyed.  Similar 
measures  might  be  adopted  iu  private  practice. 

EVII  EFFECTS  OF  EXPOSURE  TO  DRAUGHTS. 

Cold  Air Cold  air,  and  especially  cold,  moist  air,  is  so  often  a  factor 

in  the  production  of  disease  that  the  consideration  of  this  constantly  im- 
pending danger  to  health  and  its  hygienic  treatment  by  the  means  of 
Buitable  clothing  is  very  important. 

Clothing. — Contrary  to  the  popular  notion,  clothing  gives  no  heat 


188  PtTEE  AIK  AS  A  CONDITION  OF  HEALTH. 

in  itself,  but  only  saves  the  beat  of  our  bodies  from  escaping  into  the 
surrounding  air,  and  it  does  this  just  in  proportion  as  it  is  a  bad  conductor 
of  heat.  The  rate  at  which  our  raiment  carries  off  the  bodily  heat  varies 
from  that  of  a  thin  linen  coat,  for  example,  which  conveys  it  away  rapidly, 
to  that  of  a  thick  fur  coat,  through  which  the  loss  of  heat  into  the  sur- 
rounding air  is  very  gradual.  Upon  this  difference  in  conducting  power 
for  heat  tlie  relative  value  of  different  articles  of  dress  depends. 

Why  Clothing  Comforts. — ^Much  of  the  comfort  that  clothes  afford  is 
due  to  the  fact  that  they  give  what  is  called  an  "artificial  surface"  to  our 
bodies,  on  which  the  cold  air  can  act  without  our  feeling  it  so  much.  It 
is  the  absence  of  this  artificial  surface  on  the  bare  hands  and  face  which 
makes  the  fingers,  forehead  and  ears  ache  so  with  the  cold,  sometimes  in 
wintry  weather,  and  the  reason  that  people's  toes,  after  a  while,  often 
ache  in  the  same  way,  is  that  the  foot-coverings  frequently  become  chilled 
through,  so  that  they  no  longer  do  their  duty  as  protectors  against  loss  of 
heat. 

Hardening  Process. — The  process  of  "hardening  oneself"  consists  in 
rendering  the  skin  so  used  to  ghanges  from  a  warm  to  a  cold  air,  that  its 
blood-vessels  and  nerves  are  comparatively  little  affected  by  the  contract- 
ing influence  of  the  cold.  "^Making  oneself  tender,"  on  the  contrary,  is 
establishing  the  habit  of  staying  in  wai-m  air,  and  venturing  out  only  when 
well  wrapped  up,  to  such  an  extent  that  any  accidental  exposure  to  even 
moderately  cold  blasts  has  a  powerful,  or  even  dangerous,  effect.  Harden- 
ing the  skin  against  the  weather  is  just  like  hardening  the  eyes  to  a  bright 
light,  or  the  ears  to  loud  noises.  All  three  may  occasionally  prove  valuable 
accomplishments  after  they  are  acquired,  but  a  certain  per  cent,  of  the 
people  who  try  to  be  thus  accomplished  will  lose  their  lives,  or  their  eyes, 
or  their  ears,  in  the  process.  No  doubt  thousands  of  young  girls  have 
died  of  consumjition  caught  in  the  attempt  to  harden  themselves  to  going 
with  bare  amis  and  bare  necks,  in  the  costimie  absurdly  called  "full  dress" 
by  fashionable  society. 

Bangers  to  be  Avoided — In  every  effort  to  harden  oneself  against 
the  influence  of  changes  of  the  air,  and  likewise  in  the  practice  of  that 
accomplishment  after  it  is  acquired,  any  saving  of  clothes  is  often  more 
than  compensated  for  by  a  waste  of  extra  food  used  up  in  maintaining  the 
animal  heat,  through  the  process  of  burning  up  the  fatty  and  starchy 
articles  of  our  diet.  Besides  this,  a  great  and  frequently  an  unnecessary 
strain  is  imposed  upon  the  digestive  organs,  in  preparing  this  extra  supply 
of  nutriment,  and  the  nervous  system  is  also  severely  taxed  in  regard  to 
both  the  digestive  and  the  heat-regulafiug  operations,  so  that  study  or 


WEATHEE  OBSEKVATIONS.  189 

other  mental  efforts  may  be  seriously  interfered  with.  Hence  the  harden- 
ing process  should  only  be  ajjplied  to  our  bodies  in  the  most  carefully 
considered  way,  by  people  who  are,  at  the  time  the  experiment  is  tried,  in 
good  health,  and  those  especially  who  are  free  from  any  tendency,  in- 
herited or  otherwise,  to  disease. 

When  to  Venture  Out  of  Doors — As  a  substitute  for  hardening  oneself 
by  exposure  to  all  sorts  of  atmospheric  changes,  without  carefully,  regu- 
lated protection,  attention  to  the  weather  indications,  or  "probabilities," 
as  published  every  day  in  the  newspapers,  has  of  late  years  become  of 
great  imj^ortance  from  a  hygienic  point  of  view.  In  fact,  the  study  of 
sanitary  meteorology,  as  this  branch  of  the  science  might  be  called,  for 
the  purpose  of  determining  what  hygienic  precautions  in  regard  to  cloth- 
ing, ought  to  be  instituted  against  hot,  moist,  or  cold  air,  what  days  or 
what  hours  convalescent  patients,  and  especially  children,  may  venture  out 
of  doors,  when  is  the  best  time  for  invalids  to  bear  removal,  and  at  what 
periods  neuralgic  and  rheumatic  patients  must  exercise  particular  care 
against  exposure,  has  a  highly  practical,  and  sometimes  an  almost  incal- 
culable value. 

Providing  Against  Weather. — ^Any  one,  by  consulting  the  daily  "indi- 
cations" in  the  public  prints,  can  provide  against  the  weather  correctly 
about  eight  times  out  of  ten,  but  in  order  to  avoid  most  of  the  remaining 
20  per  cent,  of  blunders,  it  is  only  necessary  to  combine  the  knowledge 
obtained  from  the  signal  office  predictions  with  that  derived  from  ob- 
eervations  upon  an  aneroid  or  mercurial  barometer,  as  described  In  the 
following  pages. 

WEATHER  OBSERVATIONS. 

Signal  Service  Bureau — From  the  time  the  great  Dr.  Johnson  uttered 
his  famous  sarcasm  upon  observers  of  the  weather,  to  wit,  "A  certain  set 
of  men  pass  their  lives  in  watching  the  changes  of  the  weather,  and  die  at 
a  good  old  age  with  the  conviction  that  the  weather  Is  changeable,"  little 
has  been  accomplished  in  rendering  us  more  truly  weather-wise,  until  the 
splendid  results  attained  by  our  own  Signal  Service  bureau  gave  a  new 
impetus  to  the  sttidy  of  meteorology. 

Value  of  Weather  Observations.— Eew  can  dispute  that  not  only  the 
hyglenists  of  America,  but  also  those  of  the  Old  World,  are  under  great 
obligations  to  our  National  Government,  which,  taking  timely  advantage 
of  opportunities  never  before  presented  in  the  history  of  mankind,  has 
utilized  them  with  marvelous  success. 

Weather  Reports. — These  opportunities  consist,  of  course,  in  the  cir 


190  PURE  AIR  AS  A  CONDITION  OF  HEAl,Tir. 

cumstances,  first,  that  in.  our  American  Union  there  is  a  larger  compact 
portion  of  the  earth's  surface  inhabited  by  civilized  man,  now  under  the 
same  jurisdiction,  and  controlled  by  one  central  authority,  than  in  any 
antecedent  epoch;  and  second,  that  by  the  most  extended  sj'stem  of  tele- 
graphic communication  ever  organized,  it  has  been  possible,  during  the 
last  decade,  for  the  first  time  in  the  history  of  the  world,  to  obtain  in- 
stantaneous and  simultaneous  weather  reports  from  an  area  of  the  earth's 
surface  occupying  the  whole  breadth  of  our  continent,  stretching  from  the 
thirtieth  almost  to  the  fiftieth  parallel  of  latitude,  and  comprising  more 
than  three  millions  of  square  miles. 

Methods  of  Observing  Weather. — Over  this  vast  section  of  country 
signal  stations  have  been  established,  under  the  direction  of  the  Weather 
Bureau,  at  least  wherever  practicable,  and  to  such  extent  as  the  yearly 
appropriation  would  permit.  At  these  stations  three  observations  are 
taken  daily,  at  the  same  moment,  the  hours  selected  being  7  o'clock  a.  m., 
3  p.  M.  and  11  r.  m.,  Washington  time. 

Weather  Maps. — ^By  this  plan  the  changes  from  hour  to  hour  and  day 
to  day,  as  well  as  the  effects  which  are  produced  by  these  alterations,  are 
noted,  and  after  these  records  are  forwarded  to  the  central  office,  they  are 
reproduced  in  a  permanent  form  upon  the  daily  weather  map,  which  is 
transmitted  as  far  as  practicable  over  the  country.  Here  these  daily 
maps  may  justly  be  entitled  "the  geogi-aphy  of  our  atmosphere."  With- 
out examining  them,  we  can  uo  more  secure  an  accurate  conception  of  the 
general  state  of  the  weather  than  we  could  gain  a  correct  idea  of  the  real 
arrangement  of  seas,  continents  and  islands,  as  represented  upon  geo- 
grajihical  maps,  by  walking  a  few  miles  along  the  coast,  or  climbing  over 
a  range  of  mountains. 

Storms — By  means  of  the  extensive  series  of  observations,  carried 
on  thro\igh  several  years  by  the  United  States  Signal  Ofiice,  it  has  been 
discovered  that  storms  occur  in  areas  of  low  barometer,  rounded  or  oval 
in  form,  and  two  or  three  hundred  miles  in  diameter,  which  travel  across 
our  country,  from  west  to  east,  exactly  opposite  to  the  apparent  movement 
of  the  sun  in  the  heavens.  The  storm  therefore  is  an  immense  ring  or 
oval  of  wind,  cloud  and  rain,  which  speeds  across  the  country  about  as 
rajjidly  as  a  fast  express  train;  that  is,  from  about  300  to  600  miles  in 
twenty-four  hours. 

Direction  of  Storms. — Such  storms  usually  come  to  us  from  the  Pacific 
coast,  and  by  having  telegraphic  messages  sent  to  Washington  from  several 
of  the  western  stations  on  the  Pacific  Pailroad,  announcing  at  what  time 
the  storm  reached  each  one  respectively,  the  observers  of  the  signal  office 


WEATHER  OBSERVATIONS.  191 

can,  of  course,  tell  just  how  fast  tbat  particular  tempest  is  advancing,  and 
calculate  wlien  it  is  due  in  Washington,  exactly  as  the  railroad  officials 
can  tell,  if  they  are  informed  by  telegi'aph,  precisely  what  time  their  train 
tvill  arrive  from  the  west.  Evidently,  after  being  thus  notified,  it  is  an 
easy  matter  for  the  Washington  authorities  to  send  word  to  the  people  in 
the  neighborhood  to  get  ready  to  meet  the  rain  in  one  instance,  or  their 
friends  at  the  depot  in  the  other. 

Storm  Paths — The  path  of  an  area  of  low  barometer  across  the  con- 
tinent has  been  aptly  compared  to  the  track  of  an  immense  water-cart,  tho 
centre  of  which  is,  as  a  general  rule,  the  line  of  most  violent  storm.  Tho 
average  rate  of  motion  for  such  a  storm-centre  is  350  miles  a  day,  although 
it  may  vary  from  100  to  1200  miles  in  twenty-four  hours.  The  winds 
commonly  blow  from  all  quarters  towards  the  area  of  low  barometer,  the 
many  apparent  exceptions  being  caused  by  moimtain-ranges,  valleys,  and 
so  forth,  turning  aside  the  currents  of  air. 

Barometric  Effects. — From  this  it  follows  that,  when  the  area  of  low 
barometer  is  running  on  a  line  of  high  latitude,  the  winds  felt  in  places 
on  its  southern  margin  will  be  from  the  south,  and  vice  versa.  That  is  to 
say,  if  at  any  time  an  area  of  low  barometer  is  passing  through  !N^ew  York 
and  K"ew  England,  the  winds  in  Philadelphia  will,  in  a  general  way,  be 
towards  it  and  from  the  south;  while,  on  the  contrary,  at  any  time  when 
a  similar  area  is  traveling  through  Virginia  and  Maryland,  the  winds  in 
Philadelphia  will  be  from  the  north,  and  usually  cooler.  The  esceptions 
to  the  rule  of  north  winds  being  cooler  and  south  winds  warmer,  are 
obviously  due  to  large  volumes  of  cold  air  or  of  warm  air,  respectively, 
having  previously  been  blown  to  the  north  or  south  of  a  particular  position. 

Direction  of  Barometric  Areas — Although  the  general  direction  of  the 
areas  of  low  barometer  seems  to  be  round  the  earth  towards  the  rising  sun, 
their  course  is  sometimes  very  irregulai",  as  is  demonstrated  by  the  daily 
weather  maps,  which  occasionally  exhibit  them  traveling  almost  due  north 
for  three  or  four  days,  during  which  excursion  they  may  pass  over  a  dis- 
tance of  a  thousand  or  fifteen  hundred  miles,  before  they  resume  their 
usual  easterly  tendency.  The  storm,  as  before  remarked,  is  where  the 
area  of  low  barometer  is,  and  as  this  almost  always  approaches  us  from 
the  west  or  southwest,  most  of  our  storms  really  come  from  that  direction. 
Hence  there  is  seldom  or  never  a  true  northeast  storm,  much  as  we  hear 
people  talk  aboiit  "northeasters ;"  and  a  northeast  wind,  with  rain,  results 
from  an  area  of  low  barometer  situated  southwest  of  us,  and,  as  a  rule, 
traveling  eastward  on  a  parallel  of  latitude  one  or  two  hundred  miles  south 
of  our  position. 


192  PTJEE  AIE  AS  A  CONDITION  OF  HEALTH. 

Uses  of  tlie  Barometer. — The  use  of  the  barometer  is  especially  seen 
in  determining,  by  its  steady  and  gradual  rise,  that  the  edge  of  an  oval 
of  low  barometric  pressure  has  j^assed  over  a  particular  place.  It  also 
indicates,  by  its  gradual  fall,  the  oncoming  of  an  area  of  low  barometer, 
although  when,  as  frequently  happens,  a  storm  lags  behind  this  area  a 
little,  rain  and  wind  may  be  most  severe  with  a  rising  barometer.  The 
indications  afforded  by  barometric  observations  must  therefore  be  specially 
studied  for  each  particular  place,  and  judicially  combined  with  the  daily 
report  of  probabilities  from  the  Weather  Bureau,  in  order  to  gain  the 
greatest  advantage  in  sanitary  meteorology. 

INFLTJENCE  OF  WINDS  ON  HEALTH. 

Variety  of  Influences. — Wind  or  air  in  movement  exercises  upon 
human  health  an  iniluence  which  depends  partly  ujion  its  rapidity,  partly 
upon  the  properties  which  it  may  have  acquired  from  the  land  and  water 
over  which  it  has  passed,  and  lastly  upon  its  variations.  Its  influence  from 
these  various  causes  may  be  either  accidental  or  temporary,  or  durable 
and  more  profound.  Thus,  the  effect  of  a  cold  or  damp  wind  upon  an 
individual  who  is  in  a  free  perspiration,  as  a  consequence  of  active  exer- 
cise just  engaged  in,  may  be  t®  produce  a  cold,  a  sore  throat,  a  bronchitis, 
or  an  attack  of  rheumatism,  according  to  the  predisposition  or  weak  point 
of  the  person.  Hence,  as  already  insisted  upon,  every  man  ought  to  study 
out  carefully  his  O'wn  special  aptitudes,  under  the  agency  of  certain  ex- 
citing causes,  to  the  development  of  particular  diseases.  This  is  indis- 
putably the  part  of  wisdom,  because  it  is  far  easier  to  avoid  these  ejcciting 
causes,  which  may  so  I'eadily  bring  into  action  the  dangerous  maladies  to 
which  we  are  predisposed,  if  we  are  well  informed  concerning  the  exact 
defect  in  our  armor  against  their  power. 

Deleterious  Influences — A  wind,  if  charged  with  injurious  substances, 
siich  as  the  pestilential  effluvia  of  marshes,  for  example,  may  carry  with 
it  the  causes  of  serious  alterations  in  the  health.  Some  such  winds  pro- 
duce, in  countries  where  they  blow,  diseases  terrible  both  on  account  of 
their  severity  and  their  persistence,  and  which  cease  only  with  the  wind 
which  has  brought  them.  Difference  in  the  rapidity  of  the  movement  of 
the  air  gives  rise  to  great  variations  in  its  effects.  A  moderate  agitation  of 
the  air,  such,  for  instance,  as  a  wind  moving  ten  miles  per  hour,  is 
decidedly  favorable  to  the  proper  performance  of  the  functions  of  the 
skin,  to  the  energetic  exercise  of  the  muscular  system,  and  to  the  main- 
tenance  of   an   agreeable   temperature.      Nothing,    for   example,    can    he 


INFLUENCE  OF  WINDS   ON   HEALTH.  193 

pleasanter,  nor  in  their  way  more  healthful,  during  the  exhausting  heats 
of  summer,  than  the  sea  breezes  of  maritime  coasts. 

Sea  Breezes. — When  cool  air  is  in  rapid  motion,  however,  and  just  in 
proportion  to  that  activity,  a  great  and  speedy  abstraction  of  heat  from 
the  surface  of  our  bodies  is  perceptible.  Air  which  in  repose  gave  merely 
the  sensation  of  agi'eeable  freshness,  becomes  cold  when  in  movement,  and 
cold  air  under  a  similar  change  of  circumstances  becomes  frigid. 

Hygienic  Effects  of  Air  in  Motion. — Physiologists  have  calculated  that, 
with  dry  air  in  rapid  motion,  the  loss  of  moisture  from  the  surface  of  the 
skin  is  ten  times  as  great  as  when  the  air  is  still  and  moist.  This  fact 
explains  the  necessity  of  avoiding,  as  far  as  possible,  exposure  of  the  body 
particularly  when  perspiring  to  air  in  rapid  motion,  because  the  dangers 
of  chill  are  thereby  greatly  increased.  On  the  other  hand,  a  very  dry 
wind  rapidly  parches  the  skin,  checks  its  secretions,  which  are  so  important 
to  the  maintenance  of  health,  and  produces  a  general  feeling  of  discomfort. 
The  exaggerated  condition  of  this  prejudicial  influence  is  seen  in  persons 
exposed  to  the  celebrated  sirocco  of  the  Great  Desert  of  Sahara.  The 
influence  of  winds  depends  not  only  upon  their  humidity  and  their 
rapidity,  but  also  upon  the  nature  of  the  countries  which  they  traverse. 
The  wind  which  crosses  the  icy  peaks  of  snow-clad  mountain-ranges  carries 
with  it  for  a  long  distance  the  cold  with  which  it  is  charged.  The  town 
of  Nice,  such  a  favorite  resort  for  consumi:>tives  in  the  south  of  Europe, 
would  have  an  almost  perfect  climate  were  it  not  for  the  fierce  and  frigid 
wind  called  the  mistral,  which  occasionally  visits  it,  blo\ving  from  the 
summits  of  the  Alps  down  the  valley  of  the  Ehone. 

Effects  of  Cold  Air — Cold  encountered  without  forewarning  may  be 
the  cause  of  disease.  Too  often  it  is  a  predisposing  cause  of  disease.  Cold 
air  may  of  itself  cause  disease,  as  is  seen  in  frost  bite,  or  it  may  produce 
its  results  by  simply  making  the  system  more  vulnerable.  To  illustrate — 
it  was  formerly  thought  that  cold  was  the  cause  of  pneumonia.  We  now 
know  that  pneumonia,  like  many  other  diseases,  is  due  to  a  germ.  Many 
healthy  pei-sons  have  the  germ  of  pnemnonia  in  the  secretions  of  the 
mouth.  If  the  vitality  or  power  of  resistance  is  good  no  evil  effects  follow. 
Should  the  same  individual  be  "run  down"  for  any  reason  and  the  added 
influence  of  cold  be  present  the  germs  are  no  longer  resisted  and  pneu- 
monia results. 

Benefits  of  Winds. — But  no  cloud  is  without  its  silver  lining:,  and  if 

we  but  look  for  it,  it  may  be  found.     If  we  examine  the  subject  more 

closely  we  see  that  winds  are  responsible  for  conditions  of  health,  that 

upon  winds  or  air  in  motion  depends  the  whole  subject  of  ventilation  to  be 

13 


194  PDEE  AIR  AS  A  CONDITION  OF  HEALTH. 

discussed  later.     It  is  bj  the  motion  of  the  air  that  respiration  is  possitle. 
Impure  air  is  diluted  hy  pure  air,  and  then  rendered  purer. 

OZONE. 

Among  the  invisible  ingi-edients  of  air  sometimes  found  in  consider- 
able quantity,  but  not  always  present  in  any  appreciable  amount,  is  ozone. 

Origin  of  Ozone. — Ozone  is  made  up  of  three  atoms  of  oxygen,  whereas 
free  oxygen  is  made  of  but  two  atoms.  It  is  therefore  concentrated 
oxygen,  and  by  loss  of  one  of  its  atoms  it  is  converted  into  free  oxygen 
of  two  atoms. 

Importance  of  Ozone. — As  yet,  the  researches  of  medical  chemists 
only  enable  us  to  state  that  the  test  of  Shoeubein  indicates  that  ozone  is 
more  abundant  in  jiure  than  in  impure  air;  in  greater  quantity  at  the 
seashore  than  in  the  interior,  and  in  mountain  air  than  in  that  of  plains ; 
absent  in  the  centre  of  large  towns,  yet  present  in  their  suburbs ;  deficient 
in  the  air  of  a  hospital  ward,  yet  plentiful  in  the  atmosphere  outside. 

Ozone  in  Pine  Woods.— Dr.  Nicholson,  of  Michigan,  found  in  a  long 
series  of  observations  that  ozone  was  more  abundant  in  a  pine  forest  than 
in  the  open  country  during  the  smnmer,  but  less  abundant  during  the 
winter;  less  abundant  in  coal-pits  and  over  swamps  than  in  the  open 
country,  and  less  abundant  in  the  night  than  in  the  day. 

Property  of  Turpentine — The  results  of  these  investigations  in  regard 
to  the  air  of  pine  woods  are  in  accord  with  the  statements  of  Dr.  Schreiber, 
of  Vienna,  who  declares  that  the  turpentine  exhaled  from  pine  forests 
possesses  to  a  veiy  high  degree  the  jiroperty  of  converting  the  oxygen 
of  the  air  into  ozone,  and  this  fact  perhaps  explains  why  a  continued  resi- 
dence among  the  balsamic  odors  of  the  pines  has  long  been  credited  Avith 
a  favorable  influence  in  cases  of  consunijition.  The  test  for  the  presence 
of  ozone  in  the  air,  consisting  of  jsaper  which  has  been  soaked  in  starch 
and  iodide  of  potassiimi,  or  iodide  of  calcium,  is  not  reliable 

VENTILATION. 

Importance  of  Ventilation — Having  reviewed  the  serious  derange- 
ments to  health  that  impure  air  might  occasion,  it  behooves  us  to  consider 
some  preventive  measures  to  ward  off  disease.  The  great  remedy  against 
impure  air  is,  of  course,  proper  ventilation. 

System  of  Ventilation. — In  arranging  any  system  of  ventilation,  we 
may  assume  that  the  greatest  amount  of  carbonic  acid  (and  its  associated 
organic  material  from  the  breath)  which  may  be  allowed  in  an  inhabited 


VETfTILATION,  195 

room,  witHoTit  injurious  results,  is  sis-tenths  of  a  gallon  in  every  1000 
gallons  of  air,  as  already  mentioned.  The  first  question  then  is,  how  much 
fresh  air  must  be  supplied  every  hour  for  each  person  in  a  room,  in  order 
that  this  proportion  of  impurity  may  not  be  exceeded  ? 

Quantity  of  Air  for  a  Room. — By  experiment  and  calculation  it  is 
found  that,  in  order  to  keep  up  this  admitted  standard  of  purity,  it  is 
requisite  that  3000  cubic  feet  of  perfectly  pure  air  should  flow  into  a  room 
hourly  for  every  grown  person  occupying  it.  Of  course,  an  equal  bulk 
of  more  or  less  vitiated  air  must  escape  to  give  place  to  the  pure  air,  and 
this  bulk,  which  must  be  poured  in  and  likewise  emptied  out  hourly  for 
each  individual,  would  be  equal  to  the  contents  of  an  apartment  thirty 
feet  long,  ten  feet  wide,  and  ten  feet  high. 

When  Increase  of  Air  is  Needed — Such  a  quantity,  large  as  it  seems, 
must  sometimes  be  considerably  increased,  in  order  to  maintain  the  requi- 
site standard  of  purity.  For  example,  when  lights  are  used,  and  no  pro- 
vision is  made  for  carrying  away  the  products  of  combustion,  much  addi- 
tional pure  air  is  needed.  An  ordinary  gas-burner  consumes  the  oxygen  of 
about  twenty-five  cubic  feet  of  air  hourly,  and  produces  nearly  as  much 
carbonic  acid  as  ten  men  would  do  in  the  same  space  of  time.  Sick  people, 
especially  those  with  diseases  of  the  lungs,  and  those  affected  with  low  or 
putrid  fevers,  should  have  a  larger  quantity  of  pure  air;  and  it  has  been 
found  that,  unless  3500  or  4000  cubic  feet  are  supplied  hourly  for  each 
patient,  hospital  wards,  for  instance,  are  more  or  less  haunted  by  offensive 
odors. 

Size  of  Apartments. — The  size  of  apartments  for  human  habitation 
should  be  directly  dependent,  within  certain  limits,  upon  the  perfection 
of  the  ventilating  and  warming  apparatus,  because,  if  the  room  is  small, 
it  is  only  by  securing  a  proper  delivery  of  warm  air  that  the  occupants 
can  receive  their  allotted  3000  cubic  feet  per  head  per  hour,  without 
suffering  from  dangerous  or  unpleasant  draughts.  For  instance,  in  a 
room  containing  but  100  cubic  feet,  the  air  must  be  changed  thirty  times 
hourly,  or  every  two  minutes,  in  order  to  maintain  the  atmosphere  at  its 
standard  purity.  This  would  involve  the  necessity  of  such  rapid  currents 
of  air  flowing  through  the  narrow  space  that  it  would  be  almost  unin- 
habitable. 

Objection  to  Small  Hooms — Besides,  when  the  room  is  small,  it  is  not 
possible  to  diffuse  equally  the  air  which  enters  it,  because,  between  the 
inlet  and  the  outlet,  a  direct  current  is  apt  to  be  established,  so  that  a  good 
deal  of  the  fresh  air  passes  right  through,  without  being  of  any  use  in 
reducing  the  amount  of  impurity. 


196  PTTEE  AIK  AS  A  CONDITION  OF  HEAI,TH. 

The  Sleeping-Eoom, — The  best  authorities  assert  that,  with  ordinary 
means  of  ventilation,  the  space  for  every  grown  person  should  be  not  less 
than  1000  cubic  feet,  and  that  in  this  space  the  entire  air  should  be 
changed  three  times  each  hour.  According  to  this  rule,  a  sleeping-room  of 
ten  feet  wide,  ten  feet  high,  and  twenty  feet  long,  might  be  allotted  to 
two  people;  and  four  persons,  hut  no  more,  should  sit,  eat  or  sleep  in  a 
room  twenty  feet  square  and  ten  feet  high,  provided  it  was  well  ventilated 
in  the  ordinary  way. 

Frequency  of  Air  Changes. — If  the  best  ventilating  apparatus  is  em- 
ployed, and  the  air  is  warmed  to  the  temperature  of  about  65  degrees 
Fahrenheit,  the  air  in  a  room  may  be  changed  six  times  hourly  without 
causing  annoyance,  so  that,  under  such  exceptional  conditions,  an  apart- 
ment of  less  than  half  the  size  above  mentioned,  or  twelve  feet  wide,  four- 
teen feet  long  and  ten.  feet  high,  would  answer  for  four  people. 

Death  Eate  in  Small  Lodgings — The  dimensions  given  above  are, 
unfortunately,  very  much  larger  than  are  generally  provided  in  our 
dwelling-houses,  and  in  the  crowded  lodgings  of  the  poorer  classes  the 
allowance  of  space  for  each  person  often  falls  as  low  as  250  or  even  200 
cubic  feet.  Under  the  latter  circumstances,  the  increased  sick-rate  and 
death-rate,  and  the  general  aspect  of  what  a  celebrated  French  physician 
graphically  describes  as  "physiological  destitution,"  bear  witness  to  the 
disastrous  effects  of  breathing  impure  air  in  confined  apartments. 

Natural  Ventilation.- — A  certain  amount  of  natural  ventilation,  as 
distinguished  from  artificial  ventilation,  effected  by  contrivances  especially 
arranged  for  that  purpose,  goes  on  all  the  time  through  the  many  crevices, 
holes  and  pores  of  our  dwellings,  although  this  supply  of  air  is,  as  a  rule, 
but  a  small  part  of  what  is  necessary  for  our  health.  It  contributes, 
however,  to  the  change  which  does  progress,  whilst  we  sit  quietly  within 
our  four  walls  without  Reeling  the  least  draught. 

Relative  "Weight  of  Airs. — Since  air,  like  other  gases,  expands  or  con- 
tracts according  as  it  is  heated  or  cooled,  warm  air  is,  of  course,  lighter 
than  cold  air,  and  tends  to  escape  at  the  upper  part  of  a  room,  whilst  its 
place  is  supplied  by  cold  air,  which  flows  in  through  every  aperture  in 
the  lower  portion.  The  familiar  experiment  of  opening  a  door  leading 
to  a  cold  entry  an  inch  or  two,  and  then  holding  a  lighted  candle  first  near 
the  bottom  and  then  at  the  top  of  the  crack,  shows  very  clearly,  by  the 
way  the  flame  is  blown  inward  in  the  first  instance,  and  outward  in  the 
second,  how  strong  arc  the  currents  of  air  in  these  two  positions. 

Effects  of  Seeond-Hand  Air.— ]\rany  persons,  especially  ladies,  are  so 
sensitive  to  the  effects  of  second-hand  air  in  a  room,  that  they  can  tell 


SLEEPING   APARTMENTS.  197 

in  a  very  few  minutes,  by  the  sensations  in  tlie  bead  and  lungs,  whether 
an  agreeable  amount  of  ventilation  has  been  provided,  by  leaving  the 
door  a  little  way  open,  or  whether  it  has  been  shut  tight. 

Effects  of  Differing  Temperatures. — The  rapidity  with  which  the  neces- 
sary interchange  of  air  goes  on  through  the  crevices  of  our  doors  and 
windows  depends  very  much  upon  the  difference  between  the  inside  and 
outside  temperature.  This  important  fact  is  well  illustrated  by  the  fol- 
lowing observations  of  Pettenlcofer.  He  found  that,  in  a  room  ten  feet 
high,  ten  feet  wide  and  twenty-six  feet  long,  containing  2600  cubic  feet, 
when  the  difference  in  temperature  within  and  without  was  34  degrees, 
the  contents  of  the  apartment  changed  once  in  an  hour,  through  the  ordi- 
nary crevices  of  the  doors  and  windows.  In  the  same  room,  with  the  same 
difference  in  temperature,  but  with  a  roaring  hot  fire  in  the  stove,  the 
change  in  the  air  increased  about  one-fourth.  When,  however,  in  the 
same  room  the  thermometer  stood  at  71  degrees,  whilst  outside  it  registered 
64  degrees,  leaving  a  difference  of  only  7  degi-ees,  ventilation  went  on 
only  at  the  rate  of  780  feet  per  hour,  and  even  opening  a  window,  the 
aperture  of  which  equalled  eight  square  feet,  only  increased  the  ventila- 
tion about  one-half,  or  to  10  GO  cubic  feet.  This  experiment  was  very 
instructive,  showing,  as  it  does,  that  a  difference  in  temperature  of  34 
degrees,  with  carefully  shut  doors,  windows  and  crevices,  has  as  great  an 
influence  in  securing  a  pure  atmosphere  as  much  larger  and  quite  unob- 
structed communications  with  the  outer  air,  when  this  latter  is  of  nearly 
the  same  temperature  as  that  inside. 

Getting  Rid  of  Foul  Air — The  quickest  way  of  getting  rid  of  foul 
air  in  a  room'  is  by  cross  ventilation,  or  "peiflation,"  as  it  is  sometimes 
called.  This  is  obtained  by  opening  windows  on  opposite  sides  of  the 
apartment  when  a  moderate  breeze  is  blowing;  but  it  is  a  method  which 
cannot  be  relied  upon,  because,  if  the  outside  air  is  stagnant,  no  ventilation 
is  secured  ;  whilst,  on  the  other  hand,  if  there  is  a  strong  wind,  the  violent 
current  of  air  produced  might  be  unendurable. 

SLEEPING  APARTMENTS. 
Ventilating — In  all  rooms  which  are  occupied  most  of  the  day,  and 
in  all  sleeping  rooms,  proper  ventilation  should  be  secured  by  artificial 
apparatus  specially  designed  for  the  purpose,  as  will  be  described  in  the 
section  of  this  book  upon  Sanitary  Architecture.  In  old  houses,  until 
proper  alterations  can  be  made,  the  exit  of  foul  air  ought  to  be  pronnded 
for  by  lowering  the  windows  at  the  top,  and  the  entrance  of  fresh  air  per- 
mitted by  raising  them  at  the  bottom. 


198  PUEE  AIE  AS  A  CONDITION  OF  HEAI.TH. 

Preventing  Unwholesome  Draughts — Unwholesome  clraughts  may  be 
prevented  in  the  latter  instance  by  the  simple  device  of  fastening  a  board 
across  the  window-frame  on  the  inside,  in  such  a  way  as  to  direct  the 
incoming  current  air  \ipward  toward  the  ceiling  of  the  room.  Dr. 
Keen's  arrangement,  which  is  still  simpler  and  equally  efficient,  is  to  fasten 
with  tacks  or  pins  a  piece  of  cloth,  or  even  strong  paper,  across  the  lower 
ten  or  twelve  inches  of  the  window-frame,  and  then  raise  the  lower  sash 
more  or  less,  according  to  the  weather.  The  convenience  of  this  con- 
trivance is  increased  if  the  cloth,  instead  of  being  peiTnanently  fastened  to 
the  window-frame,  is  held  in  its  place  by  loops  of  tape,  which  allow  of  its 
easy  removal  as  occasion  requires. 

Dangers  of  Neglected  Ventilation. — If  we  but  stop  a  moment  to  con- 
sider we  cannot  fail  to  see  the  necessity  of  properly  ventilating  the  sleep- 
ing apartments.  We  are  oftentimes  surprised  at  the  neglect  of  these  all- 
important  matters  by  intelligent  people.  If  the  air  of  any  room  becomes 
imjnive  during  the  day  we  are  at  liberty  to  remove  to  another,  and  oiir 
sense  of  smell  or  perhaps  a  headache  indicates  when  such  a  change  is 
desirable.  But  during  the  night  the  senses  are  at  rest  and  the  individual 
must  breathe  again  and  again  the  foul  air  of  an  imventilated  room. 

Consumption  and  Air. — Speaking  on  the  subject  of  patients  suffering 
with  tuberculosis  or  consumption  under  treatment,  Tyson  states  the  more 
nearly  the  temperature  of  the  sleeping-room  approaches  that  of  the  out- 
doors the  more  likely  is  the  patient  to  improve.  The  same  truth  holds  in 
cases  of  health. 

ilemove  Plants  at  Night. — Plants  should  not  be  kept  in  a  sleeping 
apartment.  During  the  night  they  do  not  give  off  oxygen,  hence  their 
jn-esence  is  not  needed.  It  is  only  under  the  influence  of  sunlight  that 
the  carbonic  acid  of  the  air  is  changed  to  carbon,  which  becomes  a  part  of 
the  plant,  and  oxygen  which  supports  animal  life. 

CONTAMINATION  OF  AIR  BY  SEWER-GASES. 
Dangers  from  Cess-Pool  Germs. — A  second  great  danger  of  impure 
air  arises  from  its  pollution  by  emanations  from  sewers  and  cess-pools, 
which  frequently  contain  the  germs  of  typhoid  fever,  diphtheria  and  per- 
haps other  complaints,  as  vdll  be  more  fully  explained  under  the  head  of 
Contagion  as  a  Cause  of  Disease.  Dr.  Letheby  found  that  sewage-water 
excluded  from  the  air  and  containing  128  grains  of  organic  matter  to  the 
gallon,  gave  off  over  a  cubic  inch  of  foul-smelling  gases  per  hour  for  a 
period  of  nine  weeks. 


CONTAMINATION    OF    AIE    BT    GASE8.  199 

Poisons  in  Sewer-Gas — Of  course,  the  danger  to  persons  who  inhale 
eewer-air,  or  "sewer-gas,"  as  it  is  often  called,  depends  vei-y  mnch  upon 
whether  it  is  loaded  with  disease-poisons  as  well  as  with  foul  odors,  and 
the  instances  adduced  by  well-meaning  but  ignorant  persons,  for  the  pur- 
pose of  showing  that  the  emanations  from  sewers  have  proved  harmless, 
are  chiefly  cases  in  which  ill-smelling  gases  happened  to  be  unmixed  with 
the  poisons  of  disease. 

Proof  of  Sewer-Gas  Poisons. — It  would  be  just  as  well  to  argue  that 
because  hundreds  of  ships  cross  the  Atlantic  in  safety  every  year,  there- 
fore no  shipwrecks  ever  occur,  as  to  contend  that,  because  many  people 
breathe  sewer-gas  with  impunity,  therefore  it  is  never  injurious  to  human 
health.  That  some  sewer-gas  is  highly  deleterious  in  its  nature  is  proved 
by  the  following  stubborn  facts;  and  since  we  have  as  yet  no  tests  for 
determining  accurately  the  degree  to  which  any  particular  sewer  is  in- 
fected with  the  germs  of  disease,  our  safest  plan  is  to  cut  off  all  connection 
between  the  air  of  our  houses  and  that  of  those  dangerous  channels  for 
filth  and  disease-poisons. 

Diphtheria  from  Sewer-Gas — Dr.  William  K  Thursfield,  of  Birming- 
ham, England,  reports  that  he  traced  an  isolated  case  of  diphtheria  to 
temporary  exposure  to  sewer-gas  in  a  house  on  a  short  line  of  sewer  which 
he  knew  to  be  specifically  contaminated  by  diphtheria.  This  sewer,  when 
opened  and  examined  by  a  sur\'eyor,  j^roduced  in  him  a  severe  diphtheric 
attack. 

Typhoid  from  Sewer-Gas — Dr.  William  V.  Keating,  of  Philadelphia, 
has  detailed  at  length  four  cases  of  typhoid  fever  attributed  to  sewer- 
gas  from  tmtrapped  drain-pipes,  and  refers  to  cases  of  measles,  scarlet 
fever  and  diphtheria  in  two  other  families  ai)iiarently  from  the  same 
cause. 

Dr.  C.  W.  Chamberlain,  of  Hartford,  relates  a  remarkable  case  of 
fatal  erysipelas  which  was  seemingly  due  to  sewer-gas  from  a  waste-pipe 
carelessly  left  open  beneath  the  bed  of  the  patient. 

Vomiting  from  Sewer-Gas — ^Dr.  George  Wilson  quotes  the  account 
of  twenty  out  of  twenty-two  boys  of  Clapham,  England,  who  were  attacked, 
and  two  of  them  died,  with  violent  vomiting,  purging  and  fever  within 
three  hours  after  standing  over  a  choked-up  drain,  watching  the  workmen 
cleaning  it  out. 

Other  Examples  of  Gas  Poisons. — ISTor  are  these  isolated  instances,  for 
the  medical  journals  of  America  and  Europe  record  numerous   similar 


200  PUEE  AIR  AS  A  CONDITION  OF  HEALTH. 

examples  of  dangerons  or  fatal  effects  from  disease-poisons  in  sewer-air 
when  inhaled  by  human  beings. 

Avoiding  Sewer  Poisons — In  view  of  this  great  body  of  evidence, 
showinij  the  direct  conveyance  of  disease  by  air  from  sewers,  it  beliooves 
■us  all  to  avoid  the  access  of  snch  noxious  effluvia  into  our  houses,  or  into 
any  inhabited  place  -whence  they  can  penetrate  into  the  lungs,  which  are 
the  usual  avenue  of  entrance  into  human  systems. 

DUST  IN  THE  AIE  AS  A  CAUSE  OF  DISEASE. 

Solid  Particles. — Dust  of  various  kinds  floating  in  the  air,  and  often 
occurring  in  such  minute  particles  that  it  can  only  be  recognized  in  a 
bright  sunshine,  or  by  the  aid  of  a  beam  of  electric  light,  as  Professor 
Tyndall  has  shown,  is  far  more  potent  a  cause  of  disease  than  is  generally 
supposed. 

Danger  of  Saliva-Loaded  Dust. — Although  affections  of  the  stomach 
and  bowels  are  often  induced  by  the  introduction  of  particles  of  injurious 
dust  swallowed  with  the  saliva,  diseases  of  the  lungs  are  chiefly  to  be 
dreaded  when  air  loaded  with  substances  which  are  mechanically  or  chemi- 
cally noxious  find  their  way  to  the  delicate  mucous  membrane  which  lines 
the  recesses  of  our  pulmonary  organs.  Bronchitis,  catarrb  and  acute  or 
chronic  pneumonia,  the  latter  often  running  on  into  one  form  of  con- 
sumption, are  especially  to  be  guarded  against  in  persons  who  are  liable 
to  be  forced  to  inhale  dust  of  various  kinds. 

Unhealthy  Trades. — The  effects  of  dust  are  chiefly  dependent  for 
their  severity  on  the  large  amount  of  the  offending  material,  and  the 
angrilar,  rough  and  hard  character  of  its  particles.  A  large  number  of 
the  unhealthy  trades  are  insalubrious  especially  from  this  cause.  Thus, 
for  example,  it  is  stated  by  ]\Ir.  Simon  that,  excepting  in  one  locality, 
300,000  miners  break  down  in  England  prematurely  from  bronchitis  and 
pneumonia  caused  by  the  atmosphere  in  which  they  live.  The  one  excep- 
tion is  most  important,  because  it  occurs  among  the  colliers  of  Durham 
and  Xorthumbcrland,  where  the  mines  are  well  ventilated. 

Coal  Dust  and  Consumption. — The  sharply-angular  fragments  of  coal 
which  may  be  seen  under  a  microscope  to  constitute  coal  dust,  mechani- 
cally irritate  the  lungs  of  those  who  inhale  them,  and  often  give  rise  to 
the  kind  of  consumption  which  is  so  peculiar  that  it  is  called  miners'  con- 
sumption or  miners'  phthisis.  This  malady  alone  cuts  short  the  days  of 
an  immense  number  of  laborers  among  coal  dust,  and  after  death  their 


DUST    AS    A    CAUSE    OF    DISEASE.  201 

pulmonary  organs  are  found  filled  ■with,  sliarp  particles  of  coal,  wLicli 
teing  inhaled  with  the  breath,  become  imbedded  in  the  substance  of  the 
lung,  and  then  acting  like  a  vast  quantity  of  tiny  splinters  in  the  flesh, 
give  rise  to  innumerable  minute  boils  or  abscesses,  by  "which  the  breathing 
apparatus  is  actually  riddled  with  holes,  and  so  much  of  it  destroyed  that 
the  poor  sufferers  die  for  want  of  lung-substance  enougb  to  supply  prop- 
erly their  blood  with  air. 

Saw  Grinders'  Consumption — The  fine  particles  of  steel  and  of  sand 
thrown  off  in  grinding  saws  and  other  tools,  give  rise  to  saw-grinders'  con- 
sumption, particularly  when  dry-gi-inding  is  resorted  to,  and  unless  the 
dust  is  carried  away  from  the  workmen. 

Particles  of  Deadly  Dust — In  manufacturing  these  various  steel  and 
iron  implements,  the  rough  articles  are  firmly  pressed  against  grindstones, 
which  are  revolving  sometimes  at  the  rate  of  three  thousand  times  in  a 
minute.  Practically  it  is  found  that  the  degi'ee  of  danger  to  the  workmen 
thus  employed  depends  partly  ujaon  the  amount  of  diist  inhaled,  partly 
upon  the  character  of  the  particles  composing  this  dust,  and  partly  upon 
the  constrained  attitude  which  the  workmen  are  frequently  compelled  to 
assume. 

What  Dust  Most  Dangerous — The  gi-inding  of  needles  and  forks  is 
the  most  dangerous,  because  it  must  be  done  upon  dry  grindstones,  in 
order  to  reduce  the  chance  of  the  fabricated  utensil  becoming  rusty. 
Scissors,  razors  and  table-knives  can  be  ground  partly  upon  wet  grind- 
stones, so  that  the  men  employed  in  such  work  run  less  risk  of  injury  from 
it,  whilst  the  coarser  implements  generally  are  now,  as  a  rule,  finished 
upon  wet  stones  entirely,  so  that  still  less  danger  is  incurred. 

Grinders'  Asthma — The  gi-iuders'  consumption,  called  also  the 
grinders'  asthma  from  the  difficulty  of  breathing,  which  is  one  of  the 
prominent  symptoms,  comes  on  very  gi-adaally,  and  often  lasts  four  or 
five  years  before  it  proves  fatal.  At  first  there  is  only  a  little  dr;^  cough, 
with  scanty  expectoration;  later  on  the  mucus,  which  is  coughed  up, 
begins  to  be  reddish  from  a  minute  quantity  of  blood  mingled  with  it ;  and, 
although  there  is  no  fever,  and  the  strength  and  appetite  remain  good, 
an  examination  of  the  chest  with  the  stethoscope  reveals  serious  trouble 
in  one  or  both  lungs. 

How  Recovery  is  Possible — Still,  recovery  is  not  only  possible,  but 
probable,  at  this  stage  of  the  complaint,  if  the  workman  can  be  persuaded 
to  abandon  his  occupation;  but  if  he  persists  in  exposing  himself  to  the 
perils  incurred  by  breathing  these  dangerous  dusts  into  the  lungs,  the 


202  PUEB  AIB  AS  A  CONDITION  OI"  HEALTH. 

pulmonary  structure  soon  begins  to  ulcerate  away,  and  painful,  lingering 
death  by  consumption  follows. 

Average  life  of  Grinders. — Until  recent  improvements  in  regard  to 
grinding,  tlie  fatality  of  these  particles  of  dust,  when  inhaled  into  the 
lungs,  was  very  great.  According  to  Dr.  Holland,  the  average  age  at 
death  of  twelve  workmen  at  the  trade  of  needle-grinding  was  only  thirty 
years  and  eight  months,  and  other  authorities  give  the  duration  of  life  as 
from  thirty-one  to  thirty-five  years. 

Use  of  the  Magnetic  Plate. — In  factories  where  steel-grinding  goes 
on  to  a  very  great  extent,  the  use  of  a  large  magnetic  plate,  for  drawing 
to  itself  the  metallic  particles,  is  very  useful;  but,  of  course,  it  has  no 
power  to  purify  the  air  from  any  injurious  dust,  except  that  made  up  of 
irou  or  steel,  and  perhaps  on  this  account  it  has  never  been  popular 
among  the  workmen. 

Use  of  the  Mechanical  Fan — Another  very  efficient  method  is  to  draw 
away  the  dust  in  the  strong  current  of  air  created  by  a  powerful  me- 
chanical fan.  A  single  fan  may  be  made  to  extract  the  dust  from  several 
grinding  stones,  care  being  taken  to  have  the  opening  in  the  boxes  which 
surround  the  stones,  and  in  which  the  draught  is  set  up  underneath,  so  as  to 
extract  both  the  heavier  and  lighter  particles.  This  plan  adds  materially 
to  the  expense  of  manufacture,  and  is  therefore  not  very  popular  among  the 
mill  owners,  but  it  so  gi-eatly  diminishes  the  dangers  to  the  workmen, 
when  properly  adapted,  that  its  employment  should  be  enforced  by  law, 
in  order  to  protect  the  health  of  the  operatives. 

Danger  from  Wet-Grinding. — Although  the  introduction  of  wet-grind- 
ing for  the  coarser  tools  vastly  decreases  the  chance  of  mechanical  injury 
to  the  lungs  from  floating  particles  in  the  air,  the  artisans  are  often  kept 
covered  with  the  muddy  water  which  is  constantly  being  whirled  off  from 
the  stones.  Being  thus  exjiosed  to  the  combined  evil  influence  of  cold  and 
wet,  they  are  especially  subject  to  acute  bronchitis,  pneumonia  and 
rheumatism,  which  may,  however,  be  in  part  prevented  if  the  men  wear 
water-proof  clothing  whilst  they  are  at  work. 

Pottery  Dust. — In  the  pottery  trade  there  is  often  a  large  amount  of 
dust  made  up  of  mineral  particles,  which  are  very  irritating  to  the  lungs 
of  the  operatives  employed.  The  same  may  be  said  of  the  artisans  who 
work  at  the  trade  of  glass-making,  the  most  dangerous  department  being 
that  of  grinding  and  polishing  the  cut-glass.  Of  these  men  more  than 
one-third  are  said  to  die  of  consumption,  and  their  average  age  at  death 
is  yariously  estimated  at  from  thirty  to  forty-two  jeara, 


BUST   A9    A    OAUSH    OF    DISEASE. 

Match-Makers'  Diseases — The  makers  of  matclies,  wLo  are  exposed 
to  the  fumes  of  phosphorus,  suffer  from  a  form  of  ulceration  of  the  jaw- 
bone, if  there  hajjpens  to  be  any  uncovered  portion  upon  which  the  poison- 
ous vapor  can  act,  as  for  instance,  around  the  root  of  a  diseased  tooth. 
The  manufacture  of  many  chemical  products  is  exceedingly  dangerous  to 
health,  and  requires  special  precautions  to  reduce  its  evil  influence  as  far 
as  possible. 

Danger  of  Metal  Fumes. — In  some  trades  and  under  certain  circum- 
stances the  fumes  of  metals  or  particles  of  metallic  compounds  pass  into 
the  air,  and  render  it  very  injurious  to  health  for  those  who  happen  to 
breathe  it.  Brass-founders  are  affected  with  bronchitis  and  asthma,  as  in 
other  trades  where  dust  is  inhaled  by  the  workmen,  but  in  addition  they 
suffer  from  a  disease  called  brass-ague  or  brass-founders'  ague.  It  ap- 
pears to  be  the  result  of  inhaling  the  metallic  fumes,  perhaps  of  the  oxide 
of  zinc. 

Symptoms  of  Fume  Poison. — The  symptoms  are  tightness  and  oppres- 
sion of  the  chest,  with  uncomfortable  nervous  sensations,  followed  by 
shivering ;  unlike  those  of  genuine  ague,  are  not  periodical.  Coppersmiths 
are  apt  to  be  affected  in  a  similar  way  by  the  fumes  arising  from  the 
partly  vaporized  metal  or  from  the  solder.  Tin-plate  workers  likewise 
suffer  occasionally  from  the  fumes  of  the  soldering. 

White-Lead  Poison — Workmen  in  white-lead  manufactories  often 
suffer  in  the  same  way  from  inhalation  of  fine  powder  of  white  lead, 
chiefly  from  the  beds  in  which  oxidation  goes  on  and  in  the  process  of 
packing  the  product.  And  the  same  may  be  said  of  house  painters  to  some 
extent,  although  lead  poisoning  is  more  apt  to  occur  in  them  from  swal- 
lowing the  lead  compound  in  consequence  of  want  of  cleanliness  while 
taking  food. 

Tobacco  Dust. — Operatives  in  tobacco  factories  sometimes  suffer  from 
Irritation  of  the  throat,  nose  and  eyes  by  the  tobacco  dust,  and  there  are 
some  people  who  cannot  become  accustomed  to  an  atmosphere  of  the 
weed.  The  greatest  irritant  effect  seems  to  be  produced  in  the  manu- 
facture of  snuff,  but  with  the  large  majority  of  operatives,  if  proper  care 
and  ventilation  is  secured,  no  serious  effects  result  after  the  first  few  weeks 
or  months. 

Wall-Paper  Poisons Perhaps  the  most  common  kind  of  poisoning 

from  a  metallic  dust  inhaled  with  the  air  is  that  developed  In  persons  who 
spend  much  time  in  rooms  decorated  with  arsenical  wall  papers.  In  some 
Instances,  these  brilliant  yet  treacherous  decorations,  which  may  be  either 


204!  PtTEE  AIE  AS  A  CONDITIOIf  OF  HEALTH. 

green,  purple  or  brown  in  color,  have  been  found  to  contain  as  many  as 
thirty-seven  gi-aius  of  the  arsenical  compound  to  the  square  foot,  and 
numerous  well-authenticated  cases  of  serious  injury  to  health  from  in- 
halation of  the  atmosphere  of  rooms  in  which  this  arsenical  dust  was  con- 
stantly floating  are  on  record.  Whenever  a  person  who  occupies  a  room 
papered  with  gi-een  or  purjde  hangings  begins  without  any  obvious  cause 
to  suffer  from  headache,  nausea,  inflammation  of  the  eyelids,  dry  cough, 
muscular  tremors  and  impaired  nervous  power,  the  cause  should  at  once 
be  sought  for  upon  the  walls  of  the  apartm,ent,  and  if  the  usual  chemical 
tests  show  the  presence  of  arsenic  in  a  little  of  the  paper  which  has  been 
scraped  off,  both  the  patient  and  the  paper  should  be  promptly  removed. 
Modem  Improvements — In  recent  years  many  improvements  have 
been  made  in  machinery.  Factories  made  sanitary,  workmen  protected 
from  dangers  of  all  kinds,  laws  enacted  compelling  owners  of  factories  to 
protect  workmen;  so  that  at  the  present  time  the  operator  and  mechanic 
does  not  have  the  many  dangers  to  contend  with  he  formerly  had.  In 
many  places  illustrated  lectures  are  given,  educating  him  to  avoid  certain 
dangers  and  conditions  in  connection  with  his  work. 


INDEX  TO  PART  IV  OF  BOOK  III 

Preventive  Medicine 

Foods  and  Drinks 

Part  IV  of  Book  III  relates  to  foods  and  drinks 
and  tells  of  their  hygienic  effects  upon  the  different 
organs  of  the  human  body. 

SUBJECTS  OF  THE  TEXT 


Absorption  and  Assimilation 218 

Amount  of  Food  Required 21 1 

Animal  Food  223 

Arrangement    of   the    Teeth 213 

Arteries,  The   220 

Bile,    The    217 

Blood  Function   220 

Blood,  The 223 

Brushes,    Effect   of   Hard   Brushes   on 

the   Teeth    214 

Capillaries     220 

Care  of  the  Teeth 214 

Cell  Nourishment   210 

Cell  Organization    210 

Change  of  Fluids  and  Tissues 208 

Children's  Teeth    213 

Circulation,   Course   of 222 

Circulation,  The  219 

Classification  of  Foods 223 

Communication  of  the  Stomach 216 

Course  of  Circulation 222 

Diet    207 

Digestibility  of  Foods 225 

Distribution  of  Nutriment 219 

Effects  of  Hard  Brushes  on  the  Teeth,  214 

Fatty  Foods 224 

Fluids  and  Tissues,  Change  of 208 

Folds  of  the  Intestines 218 

Food,  Animal   223 

Food,  Meat   212 

Food,  Milk,   Property  of 212 

Food,  Mixed  212 

Food,  Object  of 207 


Food  Required,  Atnount  of 211 

Foods,  Classification  of 223 

Foods,  Fatty,  Nutritive  Proportions.  .  .224 

Foods,    Preparation   of 224 

Foods,   Relative   Digestibility   of 225 

Foods,  Saccharine  and  Starchy 224 

Foods,  What  They  Must  Supply 211 

Function  of  the  Blood 220 

Function  of  the  Tongue 214 

Gastric  Juice 217 

Glands,  Salivary 214 

Glottis,  The  216 

Gullet,  The 216 

Heart  Pulsations  221 

Heart,   Shape  of ?2i 

Heart,  The    221 

Heart- Valves,  The   221 

Human  Organs,  Structure  of 210 

Intestinal  Canal,  Structure  of 218 

Intestine,  The  Large 218 

Intestines,   Folds  of 218 

Intestines,  Mucous,  Membrane  of 218 

Intestines,  The  217 

Large  Intestine,  The 218 

Liver,  The   217 

Location   of  the  Salivary   Glands 214 

Lymphatics,    The    219 

Material,  Waste  220 

Meat  Food  212 

Milk  Food,  Property  of 212 

Mixed  Food   212 

Molar    Teeth,   The 213 

Mucous  Membrane  of  the  Intestine. . .  .218 


205 


206 


IN'DEX  TO  PAUT  IV  OF  BOOK  III. 


Muscles,  Operation  of.  See  Swallowing 

Nourishment,  Cell  210 

Number  and  Arrangement  of  Teeth,  213 
Number  and  Location  of  the  Salivary 

Glands  214 

Nutriment,  Distribution  of 219 

Object  of  Food 207 

Organization,  Cell 210 

Organs,    Structure    of 210 

Pancreas,  The 217 

Pancreatic  Fluid   217 

Preparation  of  Foods 224 

Protoplasm    210 

Pulsations,  Heart 221 

Quantity  of  Saliva 215 

Relative  Digestibility  of  Foods 225 

Saccharine  Foods   224 

Saliva,   Quantity   of 215 

Saliva,    Secretion    of 214 

Salivary  Glands,   The — 

Number  and  Location 214 

Quantity  of  Saliva 215 

Secretion  of  Saliva 214 

Shape  of  the  Heart 221 

Shape  of  the  Stomach 216 

Starchy  Foods  224 


Stomach,  The — 

Communication   of    216 

Gastric  Juice 217 

Shape   of    216 

Structure  of  Human  Organs 210 

Structure  of  the  Intestinal  Canal 218 

Structure  of  Teeth 213 

Swallowing — • 

Glottis,   The    216 

Gullet,  The   216 

Operation  of  Muscles 215 

Teeth,  The — • 

Care  of  214 

Children's  Teeth   213 

Effect  of  Hard  Brushes 214 

Molar   Teeth,   The 213 

Number  and  Arrangement  of 213 

Structure  of   213 

Tissues  and  Fluids,  Change  of 208 

Tongue,   The    214 

Function  of  214 

Valves,  The  Heart 221 

Veins,  The   220 

Waste  Material   220 

What  Foods  Must  Supply 211 


LIST  OF  ILLUSTRATIONS 


Alimentary  Canal,  The 216 

Blood  Corpuscles,  Red  and  White. ..  .223 

Cells  of  Human  Organism 210 

Circulation,  Diagram  of 221 

Circulations,  Diagram  of 222 

Circulation  of  Web  of  Frog's  Foot. . .  .220 
Colostrum  Corpuscles  in  Human  Milk,  228 

Diagram   of  Circulation 221 

Diagram  of  Circulations 222 

Diagram  of  Constituents  of  Food 227 

Folds  of  the  Intestines 218 

Human  Organism,  Cells  of 210 


Human    Milk    Containing    Colostrum 

Corpuscles    228 

Intestine,  Small,  Villi  of 218 

Intestines,  Folds  of  the 218 

Lacteals  and  Lymphatics 219 

Milk      Containing      Colostrum      Cor- 
puscles      228 

Muscles  of  Swallowing,  The 215 

Nutritive  Proportions  of  Foods 224 

Red  and  White  Blood  Corpuscles 223 

Swallowing  Muscles,  The 215 

Villi  of  the  Small  Intestine 218 


PREVENTIVE    MEDICINE 


PART  IV. 
FOODS  AND  DRINKS 


GENERAL  CONSIDERATION. 

Object  of  Food. — The  object  of  food  is  primarily  to  furnish  the  means 
for  growth,  repair,  heat  and  energy.  The  mere  gratifleatiou  of  ajjpetite, 
which  to  the  detriment  of  health  too  often  is  regarded  with  undue  prom- 
inence, is  a  secondary  consideration  and  merely  incidental  to  nature's  de- 
mand for  nutrition. 

Food,  Half  of  life's  Battle — It  has  been  said  that  "food  properly 
chosen,  properly  cooked  and  properly  eaten  is  half  the  battle  of  life,"  and 
the  practical  value  of  the  subject  will  readily  be  understood  when  it  is 
considered  that  it  plays  an  important  part,  not  only  in  maintaiuiug  health, 
but  in  modifying  and  curing  diseases. 

The  Problem  of  Diet. — If  all  members  of  the  human  family  were 
alike  it  is  obvious  that  a  bill  of  fare  could  soon  be  arranged  which  would 
give  every  person  the  most  perfect  nourishment ;  biit  as  we  each  differ,  in 
some  smaller  or  greater  degree,  from  all  others  of  our  fellowmen,  it  is 
necessary  to  study  the  problem,  of  diet,  as  modified  and  limited  by  our 
own  individual  peculiarities  and  surroundings.  Age,  sex,  occupation, 
climate,  nationality,  and  so  forth,  all  influence  the  quantity  and  the  char- 
acter of  food  required,  and,  on  the  other  hand,  the  amount  and  nature  of 
food  taken  govern  to  no  little  extent  the  temperament  and  characteristics 
of  people. 

How  Food  Affects  Races. — It  has  been  pointed  out,  and  doubtless  with 
some  trxith,  that  racial  distinctions  are  in  a  measure  the  result  of  the 
character  of  the  food  taken,  and  that  the  Irish  and  tlie  Hindu  would  not 
have  submitted  so  supinely  to  the  rule  of  England  had  their  diet,  which 
consists  chiefly  of  vegetables,  been  more  highly  nutritious  like  that  of  the 
British. 

'(507) 


208  FOODS   AXD   IJEINKS. 

How  Food  is  Appropriated. — In  considering  the  subject  of  food,  it  is 
important  to  understand  the  method  by  which  it  is  appropriated  by  the 
system  and  converted  into  blood,  flesh,  bone  and  other  tissues,  and  how 
it  is  utili;:fd  in  the  generation  of  heat  and  force. 

Change  of  Fluids  and  Tissues. — During  our  whole  lives  the  fluids  and 
the  solid  tissues  of  our  systems -are  constantly  undergoing  change.  New 
materials  in  the  form  of  infinitely  minute  particles  of  muscle,  nerve,  and 
so  forth,  are  being  produced,  •while  the  old  and  worn-out  atoms  of  these 
structures  are  removed  with  ceaseless  activity.  "While  this  incessant 
movement  of  these  constituents  of  our  bodies  is  not  perceptible  to  the  eye, 
even  when  aided  by  the  most  powerful  microscopes,  it  nevertheless  goes 
on,  and  must  go  on  as  long  as  life  continues.  In  fact,  the  researches  of 
physiologists  tend  to  show,  with  a  large  amount  of  certainty,  that  the 
health,  strength  and  vigor  of  the  whole  and  of  every  part  of  the  body  is 
in  proportion  to  its  youth  and  newness.  Thus  it  is  that  exercise,  under 
due  regulation  and  management,  is  a  hygienic  means  of  such  great  value 
in  strengthening  and  developing  the  whole  frame,  especially  the  muscular 
system. 

Relation  of  Natural  Forces. — In  endeavoring  to  reach  the  "bottom 
facts"  of  our  knowledge  in  regard  to  the  forces  we  derive  from  the  food 
taken  into  our  stomachs,  we  must  bear  in  mind  that,  in  our  own  bodies, 
as  in  the  whole  universe  around  us,  we  have,  from  a  scientific  point  of 
view,  to  deal  only  with  material  entities  of  various  kinds  and  properties 
which  we  call  matter,  such  as  the  chemical  elements  oxygen,  carbon  or 
siilphTir,  and  their  compounds ;  and  principles  of  actions,  which  we  demon- 
inate  forces,  among  which  may  be  instanced  heat,  electricity,  and  the  at- 
traction of  gravitation,  as  types. 

Natural  Forces — The  doctrine  of  the  correlation  of  forces,  abstruse 
as  it  sounds  at  first,  is  simply,  as  regards  two  of  them,  namely,  heat  and 
mechanical  motion,  an  extension  of  the  commonly  observed  fact  that 
motion,  by  causing  friction,  produces  heat,  as  we  see  in  using  an  ordinary 
Lucifer  or  friction  match.  Every  time  we  strike  a  match  we  demonstrate 
that  motion  may  produce  heat ;  and  to  expand  this  idea  into  the  doctrine 
of  correlation  (or  relationship)  of  forces,  it  is  only  necessary  to  prove  by 
careful  and  ingenious  experiments,  as  was  first  done  by  Mr.  Grove  and 
Mr.  Joule,  that  any  certain  amoimt  of  motion  applied  in  any  conceivable 
way  to  the  production  of  heat,  causes  always  exactly  the  same  amount  of 
heat,  and  contrariwise,  a  particular  quantity  of  heat  applied  to  the  pro- 
duction of  motion,  originates  always  the  same  quantity  of  movement  no 
matter  by  what  kind  of  machinery  it  is  applied. 


HOW  FOOD  NOUEISHE3,  809 

Heat  and  Motion. — In  this  way  we  can,  by  mechanical  experinfent, 
establish  the  existence  of  a  correlation — or,  to  use  the  more  familiar  word 
introduced  above,  a  relationship — between  heat  and  mechanical  motion, 
and  this  relationship  has  been  found  to  be  that  the  force  of  a  weight  of 
772  pounds  falling  one  foot  would,  if  converted  into  heat,  raise  the  tem- 
perature of  one  pound  of  water  one  degree  of  Fahrenheit's  thermometer. 

Muscular  Effort.— After  clearly  comprehending  this  idea,  it  is  only 
necessary  to  grasp  the  further  suggestion  that,  if  a  man  is  hired  to  lift  up 
again  the  weight  of  772  pounds,  which  in  falling  one  foot  gave  us  our 
unit  of  heat  (namely,  the  heating  of  one  pound  of  water,  one  degree),  we 
further  establish,  by  the  additional  experiment,  a  relationship  or  "correla- 
tion" between  the  number  of  muscular  efforts  he  is  required  to  make  and 
that  same  heat  unit. 

Food  Re(iuired — Lastly,  if  we  weigh  the  extra  beefsteak  or  half-peck 
of  potatoes  he  needs  to  eat,  to  enable  him  to  perform  so  much  extra  labor, 
we  find  out  the  equivalent  ounces  of  food  for  the  requisite  amount  of 
muscular  exertion  emi;)loyGd,  which  is  again  the  equivalent  of  our  (arbi- 
trarily assumed)  unit  of  heat,  the  quantity  of  heat  which  will  raise  one 
pound  of  water  one  degree. 

The  Four  Natural  Forces. — Thus,  even  those  readers  who  make  no 
[pretensions  to  scientific  culture  can,  it  is  hoped,  understand  the  nature  of 
that  mutual  relationship  or  correlation  which  exists  between  these  four 
natural  forces,  to  wit,  heat,  mechanical  motion  (of  falling  or  lifted 
weights),  muscular  exertion  and  food. 

What  Food  Is — Food,  then,  is  any  substance  which,  when  taken  into 
the  animal  body,  may  enter  into  such  new  chemical  combinations  that  it 
gives  out  its  dormant  force  in  the  form  of  heat,  muscular  movement,  nerve 
power,  and  so  forth. 

How  Food  Nourishes. — If  an  article  of  food  is  completely  combined 
with  oxygen  in  the  human  system,  it  yields  up  all  the  force  which  it  is 
capable  of  affording;  but  if  it  is  not  so  adapted  to  the  wants  of  the  body 
as  to  be  fully  oxidized  or  burnt  up,  part  of  its  force  passes  off  with  other 
refuse  matters,  and  is  wasted,  as  far  as  that  man's  nutrition  is  concerned. 
It  is  by  learning  how  to  avoid  this  waste,  as  well  as  to  escape  the  injury 
excess  of  undigested  food  is  apt  to  cause  to  the  digestive  organs,  that  a 
careful  study  of  the  articles  of  diet  suitable  for  each  individual,  in  accord- 
ance with  the  facts  and  conclusions  detailed  below,  may  be  made  so  profit- 
able and  beneficial  to  every  one. 
14 


210  ffOODS   AND   DKINKS. 

STRUCTURE  OF  ORGANIZED  BODIES. 

Cell  Organization. — All  animals  and  vegetables  are  bnilt  up  of  minutq, 
separate,  organized  bodies,  called  cells,  •which  are  put  together  like  stones 
in  a  pavement,  so  as  to  form  the  skin,  the  muscles,  the  nerves,  and  so 
forth.  The  cell-elements  or  cell  are  made  np  of  a  nucleus  or  central  living 
mass,  which  may  he  aptly  compared  to  the  yolk  of  an  egg. 

Protoplasm. — Around  this  nucleus  is  gathered  a  little  lump  of  formed 
material  or  protoplasm,  corresponding  to  the  white  of  an  egg,  and  the 
whole  is  enclosed  in  a  delicate  membrane  resembling  that  which  lines 
the  egg-shell.  These  cells  are  extremely  small,  varying  from  one  four- 
thotisandth  of  an  inch  to  one  five-hundredth  of  an  inch  in  diameter.  In 
the  epithelial  scales  or  cells,  which  are  packed  together  to  form  the  skin, 
as  already  mentioned,  the  average  diameter  is  about  one  fifteen-hundredth 
of  an  inch. 

Building  of  Human  Organs. — The  different  organs  of  human  bodies 
and  those  of  the  inferior  animals  are  built  up  of  cells  very  similar  to  those 
found  in  the  vegetable  kingdom,  as  is 
illustrated  by  the  adjoining  figure. 
This  cut  shows  the  liver-cells  of  man, 
•with  the  nucleus,  a,  and  oil-drops,  h,  in 
their  protoplasm.  At  c  is  depicted  a 
free  nucleus,  that  is,  one  from  which 

the  cell-wall  and  the  protoplasm  have  '   '^i^'N^i'  s 

been  accidentally  torn  away ;  and  at  d  Cells  of  Human  Organism. 

is  shown  a  large  cell  •with  two  nuclei,  illustrating  the  tendency  to  oc- 
casional twin-formation,  which  seems  to  run  throughout  all  animated 
nature. 

First  Step  Toward  Human  Development. — The  first  step  toward  the 
development  of  a  new  being  in  that  wonderful  yet  hourly  miracle  of  re- 
production, as,  for  instance,  of  a  young  chicken  inside  an  egg,  is  the  divi- 
sion of  the  yoUc  into  a  great  number  of  little  rounded  parts,  which  soon 
present  the  appearance  of  a  heap  or  miass  of  cells,  which  for  a  time 
cannot  be  distinguished  from  the  white  cells  in  the  blood  of  the  parent 
hen.  Gradually,  however,  as  the  operation  of  hatching  progresses,  cer- 
tain groups  of  these  cells  vary  under  the  influence  of  the  vital  force  from 
other  groups,  until,  by  a  continuing  process  of  development,  the  liver,  the 
heart,  the  skin,  and  so  forth,  are  completely  formed. 

Cell  Nourishment. — In  chickens,  and  birds  generally,  the  young  crea- 
ture is  nourished  until  large  enough  to  pick  up  its  own  food  by  the  contents 


MIXED  DIET. 


211 


of  the  egg,  but  in  animals  which  bring  forth  their  young  alive,  a  curious 
natural  provision  is  made  for  supplying  the  requisite  nourishment  from 
the  blood  of  the  mother.  After  birth,  however,  the  necessity  for  food 
immediately  becomes  apparent,  and  in  order  that  mere  existence  shall 
continue,  external  nourishmient  of  some  sort  must  be  regularly  supplied. 
Furthermore,  if  growth  and  complete  development  are  to  go  on,  this 
nourishment  must  be  accurately  proportioned  in  kind,  quantity  and  com- 
position to  the  exact  needs  of  the  infant  animal  or  man. 

MIXED  DIET  REQUIEED  BY  MAN. 
Analysis  of  cows'  milk  shows  it  to  contain — 

Albumen   and   casein S4.05 

Butter     43.05 

Milk    Sugar 40.37 

Salts    5.48 

Water    857.05 

Total 1,000.00 

While  this  forms  a  suitable  diet  for  young  children,  who,  though 
rapidly  growing,  expend  in  labor  comjiaratively  little  muscular  force,  it 
fails  to  meet  the  requirements  of  active  adult  life. 

Kinds  of  Diet. — iSTor,  notwithstanding  much  argument  to  the  con- 
trary, does  an  exclusively  vegetable  diet  seem  best  adapted  to  man's 
needs.  The  evidences  derivable  from  the  form  and  arrangement  of  the 
teeth,  the  structure  and  functions  of  the  alimentary  canal,  and  the  results 
of  direct  experiment,  all  indicate  that,  in  the  present  age  of  the  world  at 
any  rate,  mankind  thrives  best,  as  a  general  rule,  upon  a  mixed  animal 
and  vegetable  diet. 

Amount  of  Food  Required. — The  requirements  of  a  full-gi'own  indi- 
vidual may  be  estimated  by  accurately  determining,  as  has  been  done  by 
scientific  men,  the  quantities  of  the  chemical  elements  carbon,  hydrogen, 
nitrogen  and  oxygen,  which  are  cast  off  from  the  body  by  the  bowels,  the 
kidneys,  the  skin  and  the  lungs,  every  twenty-four  hours,  and  then  calcu- 
lating, what  quantities  of  various  articles  of  food,  containing  these  chemi- 
cal elements,  must  be  eaten  daily  to  supply  this  waste. 

What  Foods  Must  Supply — For  instance,  if  we  find,  as  some  English 
investigators  have  done,  that  a  gang  of  one  hundred  average  prisoners 
cast  off  every  twenty-four  hours,  from  their  lungs,  kidneys  and  bowels, 
about  seventy-one  and  a  half  pounds  of  the  element  carbon,  and  four 


212  FOODS   AND   DRINKS. 

and  a  quarter  pounds  of  nitrogen,  it  is  obvious  tliat  carbon  and  nitrogen 
must  be  supplied  to  this  amount  in  the  food  the  gang  of  prisoners  eat 
in  order  to  make  up  for  -n-bat  is  excreted.  If  tbey  were  to  be  fed  upon 
bread  and  water  alone  it  ■would  require  380  pounds  of  the  staff  of  life 
daily  to  keep  them  in  good  health,  because  it  requires  that  ■weight  to 
yield  the  four  and  a  quarter  pounds  of  nitrogen  ■«-hich  they  daily  cast  off 
in  the  ■ways  just  mentioned.  But  in  380  pounds  of  bread  there  are  128 
pounds  of  carbon,  ■«-hich  is  about  fifty-seven  pounds  more  than  -would  be 
needed  to  replace  -what  these  men  ■would  excrete. 

Meat  Food. — On  the  other  hand,  should  the  authorities  try  the  ex- 
periment of  giving  them  animal  food  only,  it  ■would  be  necessary  to 
allo-w  them  350  pounds  of  lean  meat,  because  no  less  than  that  amount 
■would  contain  the  seventy-one  and  a  half  pounds  of  carbon  necessary  to 
replace  the  quantity  of  this  element  excreted ;  but  lean  meat  contains  pro- 
portionately a  very  large  amount  of  nitrogen,  and  in  354  pounds  of  it  there 
•would  be  found  109  pounds,  or  105  poimds  nearly  in  excess  of  -what  the 
prisoners  really  required,  and  ■which  would  therefore  be  wasted  as  food. 

Mixed  Food. — In  the  former  case  which  we  have  supposed,  each  man 
would  have  to  eat  about  four  pounds  of  bread,  and  in  the  latter  about 
three  and  a  half  pounds  of  meat  every  day,  in  order  to  avoid  losing 
strength.  In  the  first  instance,  there  would  be  a  good  deal  of  starch  in 
the  bread,  and  in  the  second  case,  a  considerable  bulk  of  nitrogenous 
material,  which  would  be  quite  unnecessary  as  food,  and  apt  if  taken  into 
the  stomach  to  overload  it  and  derange  its  functions. 

A  True  Mixed  Diet — The  true  way  is  to  resort  to  a  mixed  diet,  and 
if  such  were  to  be  adopted  in  this  instance,  we  would  probably  find  that 
200  pounds  of  bread,  with  sixty  pounds  of  meat,  would  answer  every 
purpose.  Two  hundred  pounds  of  bread  contain,  besides  water,  sixty 
pounds  of  carbon  and  two  of  nitrogen,  and  sixty  pounds  of  meat  about 
twelve  of  carbon  and  two  and  a  quarter  of  nitrogen ;  making,  it  will  be 
observed,  exactly  the  quantity  of  each  of  the  primary  elements  cast  off 
by  the  100  men  daily  as  waste  matter  from  the  processes  of  life. 

Property  of  Milk  Food — It  is  manifest,  according  to  this  calculation, 
that  milk  is  not  accurately  suited  to  supporting  an  adult  popidation,  be- 
cause it  contains  too  little  carbon  and  too  much  nitrogen  to  supply  the 
waste.  This  excess  of  nitrogen  is  well  suited  to  the  young  animal  which 
is  actively  engaged  in  adding  to  its  muscular  development,  but  is  not 
adapted  to  the  full-gro-wn  man,  who  is  obliged  to  produce  force,  or  its 
equivalent,  heat,  by  the  slow  combustion  of  carbon  in  his  body.  It  is  to 
supply  this  excess  of  carbon,  beyond  what  exists  in  milk,  that  all  the  world 


THE   TEETH.  213 

over,  bread  or  starch,  which  is  rich  in  carbon  in  some  form,  is  gradually 
added  in  larger  and  larger  proportions  to  the  food  of  a  growing  child. 

Proper  Diet  List. — Such  calculations,  iu  regard  to  the  other  con- 
stituents of  our  food,  form  a  basis  of  the  utmost  value  for  the  economical 
arrangement  of  diet  lists,  and  the  distribution  of  limited  means,  as,  for 
example,  in  armies  and  navies,  with  the  least  possible  waste  of  the  in- 
gredients at  command. 

THE  TEETH. 

Number  and  Arrangement. — Iu  the  adult  human  being  the  teeth,  when 
perfect,  are  thirty-two  in  number,  and  are  arranged  in  the  following  order: 
First,  in  the  middle  of  each  jaw,  are  the  four  incisors  or  cutting  teeth; 
iiest,  come  one  on  each  side  of  the  group  of  incisors,  the  two  canine  or 
dog-teeth,  so-called  because  they  are  very  large  and  conspicuous  in  a  dog's 
mouth;  the  next  pair  of  teeth,  situated  just  back  of  each  canine  tooth,  are 
named  the  first  and  second  bicuspids,  on  account  of  their  having  two 
points  or  cusps;  behind  these,  again,  we  find  the  first,  second  and  third 
molars  or  grinding-teeth. 

The  Molar  Teeth. — The  last,  or  third  molars,  four  in  number,  coimt- 
ing  two  in  each  jaw,  of  course,  have  received  the  name  of  the  wisdom-teeth, 
because  they  appear  about  the  time  that  people  grow  up  and  are  supposed 
to  have  arrived  at  years  of  discretion. 

Children's  Teeth — The  permanent  teeth  are  preceded  during  child- 
hood by  a  smaller  set,  only  twenty  in  number,  which  are  styled  the  de- 
ciduous teeth,  for  the  reason- that  they  fall  out  or  are  pushed  out  by  the 
larger  and  stronger  permanent  set.  These  deciduous  teeth  begin  to  come 
through  the  gums  of  babies  when  they  are  from  six  to  twelve  months  old, 
and  unfortunately  give  rise  to  much  of  the  pain  endured  in  childhood. 
The  adjoining  figure  shows  how  the  second  set  of  teeth  comes  in  behind 
the  first,  or  deciduous  teeth,  pushing  these  latter  out  of  the  jaws  from 
the  sixth  to  the  tenth  or  twelfth  year  of  life. 

Structure  of  Teeth. — Each  tooth  has,  as  can  be  readily  seen  by  cracking 
open  one  from  a  dead  animal,  a  very  hard  outside  shell,  composed  of  what 
is  called  the  enamel,  a  softer  and  thicker  body-substance,  denominated 
dentine  or  ivory,  and  a  hollow  place  near  the  centre  of  this  dentine,  named 
the  pulp-cavity,  which  during  life  is  filled  with  a  mass  of  nerves  and 
blood-vessels.  The  pulp  or  nerve  of  a  tooth  is  exceedingly  sensitive,  and 
acutely  painful  on  the  slightest  touch,  or  even  from  mere  exposure  to  the 
air,  as,  for  examlple,  by  the  breaking  off  or  decaying  away  of  some  portion 


214  FOODS   ANT)  DBIITKB. 

of  the  dentine  or  tooth-tone  wliich  naturally  protects  it,  and  which  when 
removed  gives  rise  to  toothache. 

Care  of  Teeth — The  prevention  of  such  suffering  lies  in  avoiding  the 
decay  as  long  as  possible  by  keeping  the  teeth  clean,  refusing  corrosive 
articles  of  food  or  medicine,  and,  when  cavities  begin  to  form,  having 
them  stopped  up  or  filled  by  a  skillful  dentist  before  they  have  time  to 
reach  the  nerve. 

Effect  of  Hard  Brushes. — While  frequent  cleansing  of  the  teeth  is 
important,  it  is  not  advisable  to  brush  them  too  much  with  hard  tooth- 
brushes, and  especially  with  gritty  tooth-powders,  thus  irritating  the  gums 
and  wearing  away  the  very  enamel  which  it  is  our  object  to  preserve. 

What  to  Avoid — The  teeth  should  never  be  used  to  break  hard  ob- 
jects ;  hot  and  cold  liquids,  especially  in  quick  succession,  ought  not  to  be 
brought  in  contact  with  them,  as  in  drinking ;  and  strong  vinegar,  syrups 
and  sweetmeats  ought  likewise  to  be  kept  away  from  the  teeth.  If  candies 
are  eaten  at  all,  or  at  rare  intervals,  the  sugar  remaining  between  the 
teeth  and  around  the  gums  should  be  promptly  washed  away  by  rinsing 
the  mouth. 

THE  TONGUE. 

Tongue  Function. — Besides  being  the  organ  of  taste  and  the  chief 
agent  in  the  production  of  speech,  the  tongue  performs  an  important  duty 
in  bringing  different  portions  of  a  mouthful  of  food  under  the  molar  teeth 
during  the  operation  of  mastication  or  chewing.  This  office  of  the  tongue 
is  shown  to  he  one  of  great  usefulness,  by  the  fact  that  when  paralyzed, 
either  wholly  or  in  part,  great  difficulty  is  experienced  in  chewing  food, 
because  it  cannot  be  pushed  between  the  grinding  surfaces  of  the  back 
teeth. 

THE  SALIVARY  GLANDS. 

Breaking  up  the  food  into  a  sort  of  coarse  powder  is  only  the. first 
step  in  its  proper  preparation  for  digestion.  It  must  next  be  mixed  with 
the  liquid  of  the  mouth,  called  saliva,  which  has  the  remarkable  power 
of  turning  the  insoluble  starch  of  bread  and  other  starchy  foods  into 
sohible  sugar. 

Number  and  Location — The  salivary  glands,  whose  business  it  is  to 
manufacture  the  saliva,  are  six  in  number,  four  being  sitxiated  under  the 
tongue  and  the  jaw.  and  the  others  seated  deeply  in  the  cheeks  in  front  of 
the  ears.  These  are  called  the  parotid  glands,  and  are  remarkable  for 
Ibeing  the  parts  affected  by  the  contagious  disease  named  mumps. 

Secretion  of  Saliva — The  saliva  is  poured  out  by  different  ducts,  into 


THE  ACT   OF   SWALLOWING. 


215 


various  parts  of  the  mouth,  so  as  to  become  intimately  mixed  with  the 
food.  Its  active  principle,  named  ptyalin,  plays  a  very  important  part  in 
the  digestion  of  the  amylaceous  substances,  that  is  to  say,  articles  of  diet, 
such  as  bread,  potatoes,  corn,  and  the  like,  which  are  chiefly  composed  of 
starch. 

Thorough  Mastication. — It  is,  therefore,  highly  necessary  that  chew- 
ing should  be  performed  slowly  enough  to  give  time  for  a  sufficient  quan- 
tity of  saliva  to  be  secreted,  and  to  be  completely  mixed  with  the  food,  as 
want  of  care  in  eating  too  fast  is  apt  to  be  followed  by  the  disease  called 
dyspepsia,  as  already  mentioned.     It  is  difficult  to  urge  too  strongly  the 

importance  of  a  thorough  mastication 
of  vegetable  food. 

Quantity  of  Saliva— In  the  hu- 
man being,  the  saliva  is  produced  in 
the  quantity  of  nearly  four  pints 
daily  during  health;  but  the  secre- 
tion of  this  very  important  agent  in 
the  digestive  process  is  powerfully 
affected  by  mental  emotions,  such  as 
fear,  anger  or  pity,  and  it  is  also 
largely  influenced  by  certain  medi- 
cines, such  as  belladonna  or  deadly 
nightshade,  even  in  comparatively 
small  doses. 

THE  ACT  OF  SWALLOWING. 

Operation  of  the  Muscles The 

entire  process  of  swallowing  is  a 
series  of  associated  muscular  acts, 
quite  independent  of  the  force  of 
gravitation,  as  may  be  seen  in  animals  drinking  with  their  heads  down- 
wards. Although  these  complex  movements  follow  each  other  without  any 
check  or  pause,  it  is  common  to  divide  them  into  three  stages,  the  first  of 
■which  is  the  voluntary  one  of  pushing  the  mass  of  chewed  food  back 
to  the  upper  part  of  the  throat  or  pharynx,  so  that  it  is  grasped  by  the 
involuntary  muscles,  which  send  it  on  downward  to  the  stomach.  This 
operation  the  muscles  which  form  the  tube  called  the  throat  or  gullet  ac- 
complish by  relaxing  in  front  of  the  morsel  of  food  which  is  being  swal- 
lowed and  contracting  behind  it.    The  adjoining  figure  exhibits  the  deep 


The  Swallowing  Muscles. 


216 


POOBS   AT3D   BKINKS. 


muscles  of  the  cheek  and  the  pharynx  -with  adjoining  parts.  The  cir- 
cular muscle  of  the  mouth  (1)  and  the  buccinator  or  trumpeter's  muscle 
(2)  help  the  tongue  to  push  the  food  back  to 
the  upper  margin  of  the  gullet,  where  it  is 
seized  upon  by  tlie  three  constrictor  muscles  (3, 
4  and  5)  of  the  pharynx,  and  pushed  down  the 
gullet  or  oesophagus,  which  is  represented  as 
being  cut  off  at  6. 

The  Glottis — In  front  of  the  pharynx  is 
an  opening  into  the  windpipe  named  the  glottis, 
through  which  we  breathe,  but  which  must,  of 
course,  be  closed  during  the  operation  of  swal- 
lowing, in  order  to  prevent  our  food  from 
dropping  into  it. 

The  Gullet — The  gullet  or  oesophagus  is 
a  muscular  and  membranous  tube,  about  nine 
inches  long,  which  if  dissected  out  would  look 
very  much  like  a  thin  inece  of  rubber  hose, 
such  as  is  used  for  watering  gardens.  Its  duty 
is  to  carry  the  food  from  the  pharynx  to  the 
stomach,  and  in  order  that  it  may  not  get 
stopped  up  by  food  getting  wedged  in  it,  this 
pipe,  in  consequence  of  its  muscular  structure, 
has  the  power  of  contracting  itself  in  succes- 
sive portions  from  above  downward,  so  as  to 
push   onward    the    articles   of   diet   which   are 


being  swallowed. 


THE  STOMACH. 


The  Alimentary  Canal. 


Shape. — The  human  stomach  is  a  some- 
what egg-shaped  bag,  the  walls,  as  the  substance  of  the  bag  is  called  by 
anatomists,  of  which  are  made  up  first,  coimting  from  the  inside  outward, 
of  a  layer  or  coat  of  mucous  membrane  which  is  similar  to,  and  continuous 
with,  the  moist  red  mucous  membrane  which  we  seen  lining  the  mouth 
and  throat.  Outside  of  this  is  a  coat  of  muscular  fibres,  some  running 
around  and  others  diagonally  across  the  sack,  and  then  outside  of  these 
again  is  a  layer  of  membrane  or  skin. 

Stomach  Communication. — The  stomach  communicates,  at  its  upper 
part  on  the  left  side  of  the  body  just  below  the  heart,  with  the  gullet,  which 


THE  DIGESTIVE  APPARATUS.  217 

opens  directly  into  it,  and  it  empties  itself,  on  the  right  side,  into  the 
upper  portion  of  the  small  intestine,  through  a  sort  of  valve,  which  has 
received  the  name  of  the  pyloric  orifice,  because  the  word  pylorus  means 
a  janitor  or  gate-keeper. 

The  arrangement  of  the  stomach  and  other  fiortions  of  the  digestive 
apparatus,  or  alimentary  canal,  or  alimentary  tract,  is  well  shown  in  the 
foregoing  figure. 

Gastric  Juice. — The  whole  of  the  mucous  membrane,  or  inner  lining 
of  the  stomach,  is  filled  with  glands,  somewhat  similar  to  the  salivary 
glands,  but  so  small  that  they  can  scarcely  be  seen  with  the  naked  eye. 
These  glands  all  open  into  the  cavity  of  the  stomach,  and  their  business 
is  to  manufacture,  from  the  blood  which  flows  around  them,  in  a  network 
of  fine  blood-vessels  with  very  thin  walls,  that  important  fluid,  the  gastric 
juice,  remarkable  for  having  such  a  Wonderful  solvent  power  upon  the 
meat,  eggs  and  other  foods  which  constitute  what  is  called  the  nitrogenous 
portion  of  our  diet. 

Quantity  of  Gastric  Juice. — The  quantity  of  gastric  juice  very  much 
exceeds  that  of  the  other  digestive  fluids,  being  about  a  gallon  and  a  half 
every  twenty-four  hours. 

THE  LIVER. 

This  is  the  largest  organ  in  the  body,  being  situated  below  the  right 
lung.     Its  office  is  the  secretion  of  another  digestive  fluid  known  as  bile. 

Bile — About  one  quart  of  bile  is  daily  produced,  it  being  intimately 
connected  with  the  digestion  of  fats.  Interference  with  its  proper  secre- 
tion is  largely  concerned  with  the  production  of  constij^ation  and  the  train 
of  symptoms  ordinarily  known  as  biliousness. 

THE  PANCREAS. 

The  pancreas  is  a  long,  thin  gland,  situated  behind  the  stomach,  and 
constituting,  in  the  ox,  part  of  what  is  sold  under  the  name  of  sweetbread. 

Pancreatic  Fluid. — This  is  secreted  daily  to  the  extent  of  about  a  pint 
and  a  half.  It  supplements  the  action  of  the  saliva  and  the  bile  by  helping 
to  dissolve  the  starchy  materials  and  to  finely  subdivide  the  fatty  sub- 
stances. 

THE  INTESTINES. 

The  small  intestine  is  a  membranous  pipe  or  tube  about  twenty  feet 
long,  hut  twisted  and  looped  together  in  such  a  way  as  to  occupy  only  the 
small  space  of  a  few  inches  in  the  cavity  of  the  abdomen,  which  forms  the 


218 


FOODS  AND  DRINKS. 


lower  half  of  a  person's  trunk,  or  tody,  as  it  is  often  called,  in  contra- 
distinction to  the  limbs  and  head.  This  tube  is  continuous  with  the  pyloric 
opening  of  the  stomach  at  its  upper  end,  and  at  its  lower  extremity  empties 
into  the  side  of  a  much  wider  membranous  tube,  about  five  feet  in  length, 
called  the  large  intestine. 

Ihe  Large  Intestine. — Most  of  the  large  intestine  has  received  the 
name  of  the  colon,  and  it  may  be  justly  compared  to  the  main  sewer  of  a 
city,  into  which  pass  all  the  waste  refuse  and  foul  materials  which  are  of 
no  further  use,  and  must  be  gotten  rid  of  as 
soon  as  possible. 

STRTJCTUKE  OF  INTESTINAL  CANAL. 

Mucous  Membrane. — The  whole  intes- 
tinal tube  is  lined  with  a  mucous  membrane, 
and  in  the  small  intestine  this  has  its  inner 
siirface  covered  with  hundreds  of  thousands 
of  little  tongue-like  projections  called  villi. 
These  villi  are  represented  as  they  appear 
when  highly  magnified  in  the  marginal  illus- 
tration, which  is  a  diagram  of  a  thin  slice  cut  lengthwise  from  the  wall 
of  the  tube. 

[Folds  of  Membrane. — Although  the  intestinal  canal  is  so  prolonged  as 

to  measure,  when  stretched  out,  over 
twenty-five  feet,  its  internal  surface 
is  not  suificient  to  perform  all  the 
work  of  absorbing  the  digested  ma- 
terials of  diet.  Hence,  the  lining 
mucous  membrane  is  throvni  into 
folds,  as  shown  in  the  appended 
wood-cut,  simply  in  order,  it  appears, 
to  afford  surface  enough  for  absorb- 
ing all  the  nutriment  from  the 
articles  of  food,  and  so  disposing  of  the  substances  we  swallow  to  the  best 
and  most  economical  advantage. 


Villi  of  the  Small  Intestine. 


The  Valvute  Conniventes,  or  Folds 
of  the  Intestines. 


ABSORPTION  AND  ASSIMILATION. 

In  order  that  the  food-stuffs,  when  altered  by  the  digestive  process, 
may  be  of  any  real  use  to  the  animal  economy,  the  nutritive  materials 
must  be  distributed  through  the  different  tissues  and  organs  of  the  body. 


THE  CIRCITI.ATIOTT. 


219 


Digestion  Not  Sufficient — The  mere  digestion  of  food  is  by  no  means 
sufficient,  and  no  matter  bow  much  we  eat,  it  would  accomplish  nothing 
toward  keeping  our  muscles,  hearts  and  brains  in  active  operation,  un- 
less food-elements  were  absorbed  after  digestion  into  the  blood,  and  as- 
similated from  it  into  the  very  structure  of  all  the  different  portions  and 
organs  of  the  animal  frame. 

The  Lymphatics.- — As  shown  in  the  adjoining  illustration,  the  lacteals, 

LAC,  which  take  their 
origin  in  the  villi  of  the 
small  intestine,  converge 
and  unite  together,  meet- 
ing the  combined  lym- 
phatics of  the  lower  ex- 
tremities in  a  kind  of 
bag,  called  the  recep- 
tacle of  the  chyle,  which 
is  situated  deeply  in  the 
abdomen  and  in  front  of 
the  sjjine,  near  its  mid- 
dle. From  this  the 
mingled  chyle  and 
lymph  are  carried  along 
the  thoracic  duct,  up  to 
the  root  of  the  neck  on 
its  left  side,  where  they 
are  poured  into  the 
large  veins,  and  so  mix 
with  the  blood  and  be- 
come a  part  of  that 
vital  fluid. 

Distribution    of    Nu- 
triment— The   nutritious 
principles    of    the    food 
having  been  absorbed  by  the  lacteals  and  carried  onward  by  the  lymphatics 
to  the  general  circulation  are  now  distributed  to  the  various  organs  by 
the  blood. 

THE  CIRCULATION. 

Through  these  channels  the  blood  is  kept  in  constant  motion  by  the 
ftction  of  a  muacular  pump,  the  heart,  first  passing  into  strong-walled 


The  Lacteals  and  Lymphatics, 


230 


FOODS   AND  DEINKS. 


branching  arteries,  the  walls  of  which  gradually  become  thinner  as  the 
branches  grow  smaller.  These  end  in  a  network  of  delicate  capillaries,  or 
hair-like  tubes,  through  which  the  crimson  tide  flows  slowly  into  the  wider, 
soft-walled  veins,  ajJiJointed  to  carry  it  back  to  the  heart,  and  thus  com- 
plete the  round  of  the  circulation. 

Blood  Function — In  its  course,  it  receives  the  nutritive  materials 
from  the  stomach  and  intestines  after  digestion,  the  special  products  of 
the  liver,  spleen  and  the  IjTnphatic  glands,  and  the  oxygen  absorbed  from 
the  air  in  the  lungs.  It  therefore  contains  and  carries  to  their  destina- 
tion all  the  materials  required  for  the  chemical  and  vital  changes  of  the 
various  tissues  necessary  to  life. 

Waste  Material — "While  passing  through  the  capillary  networks  of 
the  different  organs  and  structures,  it  takes  up  the  waste  materials  re- 
sulting from  the  wearing  out  and  decay  of  these  portions,  and  carries  them 
to  the  proper  point  of  escape  from  the  body,  as,  for  example,  the  kidneys 
or  the  bowels ;  at  the  same  time  the  nutriment  needed  to  rebuild  the  worn- 
out  organs  is  allowed  to  ooze  through  the  delicate  vessel-walls  of  the 
capillaries,  and  be  diffused  into  the  surrounding  tissues. 

Capillaries — In  the  human  being  it  is  difficult  to  demonstrate  the 
circulation  of  the  blood  in  the  capillaries,  but  the  fineness  of  their  network 
and  the  pressure  of  the  blood  which 
is  kept  up  in  them  to  force  along  the 
vital  fluid  may  be  readily  shown  by 
pricking  the  finger  with  a  needle, 
the  point  of  which,  no  matter  how 
small  it  is,  can  scarcely  fail  to  pene- 
trate some  minute  blood-vessel,  and 
let  out  a  tiny  drop  of  crimson  blood. 
This  wonderful  arrangement  can  be 
most  conveniently  demonstrated  in 
the  thin  membrane  of  a  frog's  foot, 
stretched  out  vmder  a  microscope 
magnifying  two  hundred  times. 

Arteries  and  Veins. — Of  the 
two  sets  of  blood-vessels,  the  ar- 
teries, which  convey  the  blood  from 
the  heart  to  the  tips  of  the  fingers 
and  the  ends  of  the  toes,  carry  bright  scarlet  blood,  and  are  generally 
deeply  seated  in  the  interior  of  tb§  body  ^ad  Hmbs,  so  as  to  be,  as  far 


Circulation 


the   Web 
Foot. 


Frog's 


THE   CIRCULATORY  SYSTEM.  221 

as  possible,  out  of  harm's  way.  The  veins,  which  lie  more  generally  near 
the  surface  of  the  body,  as,  for  example,  just  beneath  the  skin  on  the  back 
of  the  hand  and  arm,  are  filled  with  dark  purple  blood,  which  is  much  less 
pure  than  the  arterial  fluid,  because  it  contains  large  amounts  of  the 
broken-down  materials,  the  ruins,  as  it  were,  of  the  various  bcdily  or- 
gans, which  are  now  on  their  road  to  be  thrown  away  out  of  the  system 
through  the  lungs,  the  kidneys  and  the  bowels. 

The  Heart — The  heart  has  small  chambers  at  the  upper  part  to  re- 
ceive the  blood,  and  larger,  thicker  chambers  at  the  lower  end,  called 
ventricles,  to  pump  it  oiit.  The  human  heart  is  also  double,  having  a  right 
side  made  up  of  a  moderately  strong  auricle  and  ventricle,  to  send  the 
blood  to  the  lungs,  and  a  powerful  left  side  or  left  heart,  with  a  thicker 
auricle  and  a  very  thick,  strong  ventricle,  to  drive  blood  to  all  other  parts 
of  the  body. 

The  Illustration — This  arrangement  of  the  two  independent  sides 
of  the  heart  will  be  better  understood  by  the 
aid  of  the  diagram  in  the  margin,  which  repre- 
sents the  two  sides  of  the  heart  as  separated, 
as  they  are  in  reality  in  the  human  breast, 
■'"*'«li:lll  TfiMl-H.     although  there  fastened  together  and  appar- 

ently forming  biit  a  single  organ.     The  arrows 
indicate  the  direction  of  the  blood-current  in 
the  entire  round  of  its  circulation. 
Diagram  of  the  Circulation.  Shape  of  the  Heart. — The  human  heart  is 

a  pear-shaped  muscle,  about  the  size  of  the 
fist,  hollow,  like  a  bag,  but  with  very  thick  walls.  It  is  divided  inside  by 
fleshy  and  membranous  partitions  into  four  parts,  very  much  as  a  four- 
roomed  house  is  divided  into  rooms  by  its  ceiling  and  partitions,  with 
communicating  doors  through  each  of  the  latter. 

The  Valves. — The  valves  consist  of  a  skin  or  membrane  hung  across 
each  side  of  the  opening  between  the  chambers  of  the  heart,  like  curtains, 
in  such  a  manner  that  the  blood,  in  running  one  way,  presses  them  flat 
against  the  sides  of  the  hole,  and  tlien,  as  the  heart's  contraction  attempts 
to  drive  the  vital  fluid  back  again,  some  of  the  blood  is  forced  in  behind 
the  curtains,  and  swelling  them  out  so  that  they  meet  in  the  middle,  makes 
them  entirely  shut  off  the  return-cuiTent  of  the  blood. 

Pulsations. — The  throbbing  of  the  heart  may  be  felt  on  the  left  side 
of  the  body,  near  the  lower  edge  of  the  ribs,  and  the  beating  of  the  pulse, 
which  in  health  corresponds  to  the  pulsations  of  the  heart,  at  the  wrist  and 


222 


F00r>9  AND   DEINES. 


over  the  course  of  large  arteries  elsewhere,  when  situated  su&ciently  near 
the  surface. 

Number  of  Beats — In  adult  men  these  beats  usually  number  about 
seventy,  in  women  about  seventy-five,  and  in  children  still  more  frequent ; 
in  infancy  being  about  one  hundred  and  twenty  in  a  minute,  and  decreas- 
ing in  frequency  with  increasing  years.  Within  the  limits  of  health  the 
heart's  action  may  vary  considerably,  some  habitually  having  a  rapid  and 
others  a  sluggish  pulse,  when  in  the  same  individual  such  conditions  as 
exercise,  emotion,  depression  or  even  the  process  of  digestion,  may  de- 
cidedly modify  its  frequency. 

Course  of  Circulation. — The  left  side  of  the  heart,  marked  L.  H.  in  the 
figure,  pumps  the  blood  into  the  systemic  arteries,  and  thus  keeps  these 
vessels  over-filled;  the  larger  systemic  arteries.  A.,  by  their  elasticity, 
exert  continuous  pressure  on  the  blood  with  which  they  are  distended; 
the  smallest  systemic  arteries.  A',  by  their  vital  contractility,  check  and 
regulate  the  amount  of  blood  flowing  out  of  the  larger  arteries  into  the 
capillary  network,  and  thus  keep  up  the  constant  pressure  or  tension  in 
the  larger  arteries ;  the  systemic  capillaries,  marked  S.  C,  are  the  portions 
of  the  vascular  system  where  the  great  opera- 
tions of  the  blood  are  carried  on,  that  where 
the  worn-out  particles  from  all  the  tissues  of 
the  body  are  removed  and  the  new  atoms  for 
rebuilding  these  same  tissues  are  siipplied; 
the  wide  systemic  veins,  V.,  are  the  passive 
channels  conveying  the  impure  blood  back  to 
the  right  side  of  the  heart;  the  right  or  pul- 
monary side  of  the  heart,  E.  H.,  pumps  the 
blood  into  the  arteries  of  the  limgs  and  dis- 
tends them,  though  less  fully  than  is  the  case 
with  the  systemic  arteries;  by  the  pulmonary 
arteries,  P.  A.,  the  blood  is  carried  through 
the  pulmonai-y  arterioles  or  smallest  arteries, 
Ta,  to  the  pulmonary  capillaries,  P.  C,  where 
it  is  exposed  to  the  inbreathed  air  and  ex- 
changes its  poisonous  carbonic  acid  for  the  ac- 
tive life-giving  oxygen ;  the  letters  L/i  indicate 
the  lymphatics,  ending  in  the  thoracic  duct,  as 
already    described,    and    receiving    in    their 

course  the  lacteals,  "Lc,  which  absorb  the  nutriment  of  the  food  from  the 
stomach  and  intestines,  designated  by  I.  in  tlie  diagram. 


sx^ 


Diagram  of  Both  Circulations. 


CLASSIFICATION   OF   FOODS.  223 

Description  of  Blood — Human  blood,  when  exposed  to  the  air,  from 
which  it  rapidly  absorbs  oxygen,  is  of  a  bright  scarlet  color;  but  when 
deprived  of  oxygen  it  is  dark  purplish-red.  This  diiference  is  the  great 
characteristic  distinguishing  arterial  from  venous  blood,  and  should  always 
be  borne  in  mind  when  attempting  to  staunch  the  bleeding  from  a 
woimd,  since  entirely  different  treatment  is  needed  in  the  two  cases. 

Red  Corpuscles — The  blood  is  not  a  red  iluid,  as  it  appears  to  be  when 

first  shed;  it  is  composed  of  a  watery  por- 
^_^  tion,  called  the  plasma,  which  has  a  light 

^'4~~'^   ^^  \  /  (^^  ("a^       yellow  color,   and  an  immense  number  of 

minute  corpuscles,  which  give  to  the  blood 
its  crimson  hue.     These  little  bodies,  which 
'  \^  are  called  the  red  blood  corpuscles,  are  ex- 

Red  and  White  Blood  Corpuscles,    hibited  in  different  positions  in  the  accom- 
panying cut,  as  they  appear  when  highly 
magnified;  the  illustration  also  shows  two  white  or  colorless  corpuscles, 
one  on  the  extreme  left  in  a  rounded  condition,   and  the  other  at  W, 
misshapen  and  entangled  in  some  fibrin  threads. 

CLASSIFICATION  OF  FOODS. 

The  foods  may  be  divided  into  the  following  classes: 

1.  Nitrogenous  substances,  or  proteids,  which  go  to  form  the  tissues 
of  the  body,  and  are  represented  by  meat,  eggs,  the  casein  of  milk,  and 
other  substances  consisting  chiefly  of  albumen. 

,  2.  The  fatty  or  heat-producing  aliments,  which  are  derived  from 
both  the  animal  and  vegetable  kingdoms,  although  chiefly  from  the  former ; 
they  include  the  animal  fats,  such  as  lard  or  suet,  butter  and  tlie  vege- 
table oils,  among  which  that  from  the  olive  is  the  one  most  consumed  by 
civilized  man. 

3.  The  carbo-hydrates,  of  substances  containing  carbon  and  hydro- 
gen without  nitrogen ;  these  are  the  saccharine  or  sugary,  and  the  amy- 
laceous or  starchy  ingredients  of  human  diet,  comprising  therefore  sugar, 
molasses,  bread,  potatoes,  beans,  etc. 

4  The  saline  or  salty  articles,  consisting  largely  of  common  kitchen 
salt,  with  potash,  lime,  magnesia,  and  a  little  iron  in  various  combina- 
tions. These  ingi-edients  of  the  human  body,  small  as  some  of  them  are 
in  amount,  possess  a  very  great  importance. 

Animal  Food. — When  men  are  called  upon  to  perfonn   any  extra 


224:  POODS   AND  DKINKS. 

amount  of  severe  labor,  involving  gi-eat  muscular  exertion,  there  is  no 
doubt  that  an  additional  supply  of  meat  is  of  great  sei-vice. 

Fatty  Foods — In  regard  to  the  functions  of  the  fatty  constituents 
of  food,  we  may  at  once  conclude  that,  since  the  diet  resorted  to  by  in- 
habitants of  cold  countries  invariably  contains  a  large  proportion  of  fatty 
ingredients,  these  elements  play  an  important*  part  in  the  maintenance  of 
animal  heat.  Indeed,-  it  has  been  demonstrated  by  experiment  that  the 
respiratory  or  heat-producing  powers  of  fat  are  two  and  a  half  times 
greater  than  are  those  of  the  vegetable  hydro-carbons,  such  as  starch  or 
sugar. 

Saccharine  and  Starchy  Foods. — The  saccharine  and  starchy  constitu- 
ents aid  the  fatty  matters  in  develoj^ing  animal  heat,  although  they  are 
much  less  efficacious  in  this  respect.  Starch  is,  however,  cajJable  of  being 
rapidly  converted  into  fat  by  the  wonderful  operations  of  nature's  labora- 
tory, as  we  see  in  the  process  of  fattening  pigs  upon  corn  for  market,  and 
in  this  way  a  large  store  of  the  best  heat-producing  materials  may  be  laid 
up  in  the  system  as  a  provision  for  the  winter's  cold. 

PKEPARATION  OF  FOODS. 

Soups  and  Broths. — Where  economy  of  nutriment  is  an  important 
object  to  be  attained,  it  is  probable  that  the  production  of  broths  and 
soups,  from  vegetables  and  meat  in  combination,  affords  many  and  great 
advantages.  In  making  nutritious  broths  with  a  fair  allowance  of 
butcher's  meat,  it  is  advisable,  when  possible,  to  cook  the  vegetables  sep- 
arately, and  the  meat,  if  intended  to  be  eaten  with  the  soup,  should  be 
cut  up  into  small  pieces.  In  any  case,  the  meat  should  be  put  into  cold 
water,  but  should  not  be  boiled,  except  when  the  vegetables  are  cooked  in 
the  same  utensil,  a  temperature  of  about  150  degi'ees  Fahrenheit  being 
quite  sufficient.  If  the  meat  is  plunged  into  hot  or  boiling  water  at  the 
outset,  the  external  layer  of  albumen  is  coagulated,  and  the  juices  are 
prevented  from  exuding. 

Boiled  Meat. — In  boiling  meat,  on  the  other  hand,  when  the  object 
is  to  retain  as  much  as  possible  of  the  soluble  juices  in  the  meat,  the  piece 
ought  to  be  of  good  size,  and  it  should  at  once  be  plimged  into  boiling 
water,  to  coagulate  the  outside  albumen.  After  being  kept  boiling  for 
about  five  minutes,  the  saucepan  should  be  placed  aside,  and  the  tem- 
perature allowed  to  lower  gradually ;  or  it  may  be  lowered  by  the  addition 
of  three  pints  of  cold  water  to  each  gallon  of  boiling  water. 

Boiled  Fish. — In  boiling  fish,  the  addition  of  salt  makes  the  flesh 


NUTRITIVE  PROPORTIONS  OF   FOODS        225 


90        lOO 


Pou»i4>«9 


Spinach 


li 


Salts.       Albumin.        Starch,  Fat. 

•ucar. 


Water.      Indlgestlbla 
Subitancei. 


DIGESTIBILITY    OF    FOODS.  227 

I 

firmer  and  more  retentive  of  the  flavor.  In  cooking  green  vegetables, 
they  should  first  be  carefully  washed  in  cold  water,  but  not  allowed  to 
remain  in  it,  then  plunged  into  boiling  water  and  cooked  rapidly.  Po- 
tatoes should  be  boiled  in  their  skins,  and  after  boiling  for  about  five 
minutes  most  of  the  water  should  be  poured  off,  and  then  the  potatoes 
should  be  steamed. 

Roasted  Meat. — In  roasting  meat,  the  joint  should  be  placed  at  first 
before  a  brisk,  hot  fire,  with  a  view,  as  in  boiling,  to  coagulate  the  outside 
albumen,  and  then  the  roasting  may  bo  conducted  more  slowly. 

Stewed  Meat. — Stewing  lias  this  advantage  over  dry-baking — that 
there  is  no  risk  of  charring,  and  the  meat  is  rendered  juicy  and  tender. 
Tough  and  strong-flavored  meats  are,  perhaps,  best  cooked  in  this  way, 
because  they  can  be  rendered  very  palatable  and  digestible  by  the  addition 
of  vegetables  and  seasoning. 

Fried  Meat. — Frying  is  even  worse  than  baking,  unless  very  carefully 
done;  but  broiling  on  the  gridiron  is  an  excellent  way  of  cooking  chops, 
steaks,  kidneys  and  small  dishes  of  fish  or  fowl. 

lElATIVE  DIGESTIBILITY  OF  FOODS. 

Not  until  1825  was  the  question  of  the  relative  power  of  the  stomach 
to  digest  different  foods  satisfactorily  demonstrated. 

Liquids. — Liquid,  such  as  water,  both  pure  and  when  containing  a 
small  amount  of  nutriment  in  solution,  as  is  the  case  with  beef-tea  or 
broth,  are  often  quickly  absorbed  by  the  lining  membrane  of  the  stomach, 
very  much  as  water  is  sucked  up  by  a  sponge,  and  pass  directly  into  the 
blood. 

Milk — Milk  is  usually  coagulated  or  clotted  as  we  see  it  when  curdled 
by  rennet,  which  is  the  dried  stomach  of  the  calf,  by  one  of  the  ferments 
in  the  gastric  juice,  but  it  is  commonly  soon  dissolved  again  and  absorbed. 

Bread. — Wheat-bread  composed,  as  already  mentioned,  chiefly  of 
starch,  cannot  be  regarded  as  holding  a  place  among  the  quickly  digestible 
foods,  since  it  has  been  found  to  require  nearly  three  hours  and  a  half  for 
solution. 

Eg^gs. — Eggs,  if  eaten  raw,  may  be  digested  in  two  hours,  but  if 
boiled  soft  may  take  three  hours,  and  if  hard  boiled  or  fried,  require 
three  and  a  half  hours  for  digestion. 

Meats — Meats  of  various  kinds  differ  a  good  deal  in  their  digestibil- 
ity; thus,  for  example,  boiled  turkey  has  been  found  to  disappear  from 
the  stomach  in  about  two  hours  and  a  quarter;  boiled  lamb  in  two  and  a 


228  FOODS   AND   DEINKa 

half  hours,  and  roast  beef  in  three  hours ;  while  fried  pork  requires  over 
four  hours,  and  roast  pork  five  hours  and  a  quarter  for  complete  digestion. 

Fish. — Fish  prove,  as  a  rule,  more  easy  to  digest  than  meats;  and 
the  ordinary  vegetables  present  less  difficulty  to  the  action  of  the  stomach 
than  bread,  boiled  rice  being  particularly  manageable  and  requiring  only 
about  an  hour  for  its  entire  solution. 

Rules  Eegarding  Meals.^In  regard  to  the  periods  for  eating,  experi- 
ence proves  that  habit  is  one  of  the  most  important  agents  in  determining 
the  times  we  ought  to  partake  of  nourishment.  When  a  systematic  regu- 
larity in  respect  to  the  period  when  we  introduce  food  into  the  stomach 
is  observed,  the  digestive  processes  are  all  better  accomplished,  and  the 
food  is  more  thoroughly  and  completely  assimilated,  than  when  meals  are 
eaten  irregularly. 

Time  for  Meals — The  prevailing  custom  in  this  country  is  to  break- 
fast, soon  after  rising  in  the  morning,  on  food  nourishing  enoiigh  to  repair 
the  exhaustion  consequent  upon  the  long  fast  of  the  night,  and  yet  not  so 
heavy  as  to  overload  the  stomach  during  the  morning,  when  the  most 
active  exertion  of  the  day  is  usually  performed.  Whether  the  most  sub- 
stantial meal  be  taken  at  mid-day  or  in  the  evening  must  depend  largely 
upon  individual  preference,  convenience,  occupation,  and  so  forth. 

Exercise. — A  very  deliberate  walk  for  half  an  hour  or  so  in  the  open 
air,  when  the  weather  is  not  too  cold,  accompanied  by  the  stimulus  of 
cheerful,  but  not  exciting  nor  absorbing,  conversation,  is  a  material  aid 
to  digestion. 

Thorough  Mastication. — As  already  indicated,  the  thorough  mastica- 
tion of  articles  of  diet,  especially  by  the  third  set  of  teeth,  is  essential  to 
proper  digestion,  because,  during  this  process  of  chewing,  nature  intends 
not  only  that  the  alimentary  substances  shall  be  broken  up  into  a  coarse 
powder,  but  also  that  this  powder  shall  be  completely  mixed  with  the 
saliva,  which  has  a  powerful  influence  in  preparing  the  starchy  ingredients 
for  solution.  Hence  persons  should  cat  very  slowly,  chew  thoroughly  and 
move  the  mouthful  of  food  freely  about  from  one  cheek  to  another,  in 
order  to  amply  impregnate  it  with  the  fluids  of  the  mouth,  and  this  pre- 
caution is  particularly  valuable  when  the  food  happens  to  be  less  digestible 
in  quantity  or  quality  than  is  customary. 

The  diagram  on  following  page  shows  the  percentage  of  the  different 
nutritious  elements  of  food  in  eight  of  the  common  articles  of  diet. 

Effects  of  Overeating. — An  English  observer  has  calculated  that  for 
every   death   from   starvation,    seven   occur   from   the   effects   of   over- 


DIGESTIBILITY    OF    FOODS. 


229 


indulgence  in  food.  When  the  stomach  is  overloaded  -with,  food  beyond 
its  powei'  of  digestion,  nature  often  relieves  the  abused  organ  by  the 
process  of  vomiting,  which  no  doubt  frequently  saves  jjeople  who  violate 
the  laws  of  hygiene  in  this  respect  from  the  penalty  of  death,  or  at  least 
of  prolonged  illness.  When,  however,  the  digestive  organs  are  not  un- 
loaded in  this  manner,  the  ordinary  chemical  changes,  which  occur  in 
warm,  moist  animal  and  vegetable  matter  outside  of  the  body,  set  in,  and 
fermentation  or  putrefaction  occur,  large  quantities  of  gas  being  some- 
times produced. 

Excess  i)f  Nitrogenous  Food — When  a  superabundance  of  proteid  sub- 
stances is  eaten,  and  perhaps  imperfectly  digested,  whilst  at  the  same  time, 
as  often  happens,  a  diminished  quantity  of  exercise  or  labor  is  performed, 
there  must  almost  necessarily  be  a  disproportion  between  the  oxygen  in- 
haled by  the  lungs  and  the  nitrogen  absorbed  from  the  food,  when  they 


BnuAN  MrLE  .  . 
Cow's  Milk  .   .   . 

Meat • 

Fish    ...... 

Peas  and  Beans 
Potatoes   .  .  .  • 


ProleidL  Fats.  Carbohydrates.        Water. 


7fi   6 

■m 

mm 


W. 


io 


l^jftatlWIi         ftSe 


68 


IP 


^H 


2^5 


Grees  Veqetaelbs  wM^^^g^5g~=^ 

jBpTKATt , 


^ 


36 


Constituents  of   Foods. 


meet  in  the  blood,  and  therefore  a  disturbance  of  the  assimilative  pro- 
cesses. It  is  probable  that  gouty  and  perhaps  rheumatic  affections  arise 
partly  in  this  way,  although  the  direct  influence  of  certain  alcoholic  drinks 
in  producing  gout  is  indisputable. 

Excess  of  Starchy  Food. — Superabundance  of  starchy  articles  of  diet 
appears  to  be  less  directly  hurtful  to  the  system,  because  a  larger  propor- 
tion of  the  excess  passes  off  from  the  bowels  in  an  unchanged  condition. 


230  FOOnS  AND   DEINKS. 

Troublesome  corpulence  may  sometimes  result,  however,  from  eating  too 
much  starchy  food,  and  it  has  been  supposed  that  attacks  of  diabetes,  a 
disease  which  is  characterized  by  the  presence  of  sugar  in  the  urine,  are 
occasionally  due  to  the  same  error  in  diet. 

Contaminated  Food. — Food  is  often  rendered  unwholesome  and  unfit 
for  use  by  inherent  disease  by  contamination  with  poisonous  substances 
and  by  putrefactive  changes.  Moreover  the  peculiar  power  of  absorption 
possessed  by  some  foods,  as  milk,  pineapples  and  bananas,  is  capable  of 
causinp:  the  transmission  of  certain  diseases. 

Decomposing-  Food. — Decomposing  food  may  give  rise  to  alarming  and 
fatal  poisoning  through  the  absorption  of  septic  materials  into  the  system. 
It  is  probable  that  where  chemical  analysis  fails  to  reveal  a  cause  for  death, 
many  cases  giving  evidence  of  violent  gastro-intestinal  intlanmiation  or  of 
profound  impression  of  the  nerve  centres,  are  in  reality  due  to  such  causes. 
Meat  of  Diseased  Animals, — The  meat  of  animals  affected  with  such 
diseases  as  pleuro-pneunionla,  murrain,  anthrax,  tuberculosis,  Texas  cattle 
fever  and  parasitic  affections,  as  tape  worm  and  trichiniasis  are  unfit  for 
food,  and  precautions  should  be  obser^'ed  to  guard  against  their  employ- 
ment. 

Adulteration  of  Milk. — The  results  of  the  adulteration  of  milk  are 

mainly    those    caused    by    withholding 

certain  nutritious  principles  from  the 

food    supply.     Their    evil    effects    are 

seen  particularly  in  infants  fed  upon  ^o^°i°c* 

cow's  milk,  who  are  thus  deprived  of        ^^i°''°°° 

much  that  is  necessary  to   their  sub-        ^°^^^''  ©o*.°  ob'IVo'^S^M^; 

sistence    and   growth.      The   skimming       g^<.o':^'-°'»=d°o*®\^?§it4^ 

of  milk,  or  the  addition  of  water,  are        ^^RO?°'^s«°<?<?.o'', '" 

alike  productive  of  this  result.  ^^*'«>'^«°o^Q5to 

Transmission  of  Disease  by  Milk —  ^focSn^^Sf^^'-IS^^l? 

The    results   ot   investigation   into  the  ^^BgS4*oJj*'^ 

causation  of  numerous  epidemics   and        ,,  tl,u   r-    .  ■  ■      ^  i    » 

_  /  .  Human  Milk  Containing  Colostrum 

isolated   cases    of   contagious     diseases  Corpuscles, 

have  shown  conclusively  that  some  of  these  are  capable  of  being  conveyed 
through  the  agency  of  milk.  By  carelessness  in  cleansing  dairy  utensils, 
by  feeding  cows  with  contaminated  food  and  watering  them  from  stagnant 
or  infected  pools  and  by  exposing  the  milk  to  foul  and  poisonous  emana- 
tions, milk  may  become  a  source  of  danger  to  those  who  take  it.  Among 
the  diseases  which  have  been  often  spread  in  this  way  are  the  following: 
Tuberculosis,  typhoid  fever,  scarlet  fever,  diphtheria,  and  so  fortk. 


INDEX  TO  PART  V  OF  BOOK  III 

Preventive  Medicine 

Outward  Enemies  to  Health 

Part  V  of  Book  III  deals  briefly  with  many  out- 
ward enemies  to  health,  such  as  light,  heat,  climate, 
soil,  etc. 

SUBJECTS  OF  THE  TEXT 


Blood,    Cold    and , 234 

Climate,    Diseases   Affected   by 233 

Climate,    Soil    and    Health 235 

Climates,  Traveling  in  Hot  Climates,  233 

Clothes      234 

Clothing,    Poisoned    234 

Clothing,    Regulation   of    234 

Cold  and  the  Blood  , 234 

Cold  as  a  Cause  of  Disease   233 

Cold  and  Elderly  People   233 

Cold,   Local   Injuries  from    234 

Cold   and   Perspiration    234 

Colored   Light    234 

Contagion     235 

Disease,  Cold  as  a  Cause  of   233 

Disease   and   Heat    233 

Diseases  Affected  by  Climate    233 

Electricity      235 

Electricity  in   Medicine    235 


Eyes  and  Light  234 

Health,   Climate   and   Soil    235 

Heat    and   Disease    233 

Heat  of  the  Sun   233 

Hot   Climates,  Traveling  in    233 

Injuries  from  Cold   (local)    234 

Light     234 

Light  and  the  Eyes 234 

Lights,    Colored    234 

Morbid    Poisons    236 

Perspiration   and   Cold   234 

Poisoned    Clothing    234 

Poisons,    Morbid    236 

Regulation   of   Clothing    234 

Soil,  Climate  and  Health   235 

Soils     23s 

Sun's   Heat,  The    233 

Sunstroke 233 

Traveling  in  Hot  Climate  233 


2:n 


PREVENTIVE    MEDICINE 


PAET    V. 
OUTWARD  ENEMIES  OF  HEALTH 

Heat  and  Disease. — Heat  becomes  a  predisposing  cause  of  disease  as 
soon  as  the  temperature  rises  above  70  degrees  or  80  degrees.  When 
it  begins  to  affect  healthy  life  the  pulse,  the  heart  action  and  respiration 
are  quickened.  The  skin  and  lungs  are  unable  to  equalize  temperature, 
and  the  condition  of  the  entire  body  becomes  one  of  susceptibility  to 
disease. 

The  Sun's  Heat. — Exposure  of  the  body  for  long  periods  to  the  beat 
of  the  sun  is  apt  to  result  in  more  or  less  serious  disturbances,  such  as 
congestions,  brain  hemorrhages,  meningitis,  etc.  Hence  the  need  of  pro- 
tection against  the  direct  rays  of  the  sun. 

Sunstroke — Sunstroke,  or  thermic  fever,  is  the  res^ilt  of  exposure  to 
heat  rays.  Its  early  symptoms  are  faintness,  thirst,  great  heat  and  dryness 
of  skin,  with  prostration.  As  quickly  as  possible  the  body  should  be  sub- 
jected to  the  ice  or  cold  water  treatment  to  neck  and  head. 

Traveling  in  Hot  Climates — Do  not  travel  during  the  heat  of  the  day. 
Protect  the  person  by  some  covering  which  will  deflect  the  sun's  rays. 
Rest  during  the  mid-day  hours.  Content  yourself  with  a  scanty,  unstimu- 
lating  diet.  Use  gently  stimulating  baths.  Wear  thin,  light,  loosely-fit- 
ting clothes. 

Cold  as  a  Disease  Producer — Cold  becomes  a  disturber  of  bodily  func- 
tion as  soon  as  it  falls  to  a  temperature  which  ceases  to  be  agreeable. 
The  tissues  shrink,  the  capillaries  grow  sluggish,  perspiration  is  sup- 
pressed, sensibility  is  impaired. 

Sudden  Cold. — Sudden  falls  of  temperature  are  marked  by  a  long 
train  of  diseases,  or  by  aggravated  or  fatal  turns  to  existing  diseases. 
This  is  particularly  true  of  consumption,  catarrh,  influenza  or  grippe  and 
bronchitis. 

Cold  and  Elderly  People. — From  thirty  years  on  the  humaji  body 


234;  OUTWAED  ENEMIES  OF  HEALTH. 

begins  to  draw  on  its  surplus  power.  This  power  is  constantly  diminish- 
ing as  we  age.  Hence  cold  affects  the  aged  most  seriously  by  calling 
largely  on  a  diminishing  power.     It  is  difficult  to  sustain  a  "blood  heat." 

Cold  and  Perspiration — Cold  produces  disease  by  checking  perspira- 
tion, thus  preventing  the  escape  of  injurious  materials  from  the  blood, 
and  throwing  more  work  on  kidneys  and  lungs,  which  often  become  over- 
taxed. 

Cold  and  the  Blood. — Cold  tends  to  drive  the  blood  from  the  blood- 
vessels to  the  surface,  thus  filling  one  or  more  of  the  circulating  organs 
too  full  of  blood.  If  any  of  these  vessels  be  weak  the  man  is  handicapped 
in  his  battle  against  disease. 

Clothes. — The  body  loses  heat  by  radiation,  by  evaporation,  by  rapid 
air  movement.  Hence  the  necessity  for  clothing,  which  cuts  off  radia- 
tion of  heat,  interferes  with  the  evaporation  from  the  body,  and  limits  the 
conduction  of  heat  by  rapid  air  movements.  Clothing,  therefore,  plays 
a  most  important  part  in  warding  off  diseases  and  disease-producing 
conditions. 

Begulation  of  Clothing — Garments  worn  next  the  skin  should  be  of 

wool  or  silk,  as  best  absorbents  of  perspiration,  and  as  non-conductors  of 

*  heat.    Weights  may  be  light  or  heavy  according  to  the  seasons  or  different 

constitutions.    White  or  gray  clothes  are  preferable  to  black,  when  one  is 

subjected  to  direct  solar  heat. 

Poisoned  Clothing. — Clothes  made  of  dyed  materials  are  sometimes 
injurious  to  health,  as  containing  poisons.  This  is  particularly  so  of  bright 
colored  stockings  or  underclothing. 

Local  Injuries. — Cold  gives  rise  to  painful  local  affections,  such  as 
frost-bite  and  chilblains,  the  former  involving  the  nose,  ears  and  fingers, 
the  latter  the  feet.  Heat  applications  in  any  of  these  cases  must  be 
avoided.     The  cold  treatment  is  best. 

light — Light  has  a  powerful  effect  on  the  system,  through  both  the 
blood  and  ner\'es.  It  is,  therefore,  an  active  agency  in  the  generation  of 
diseases  and  their  cures.  It  is  the  essential  of  all  growth,  and  particularly 
affects  the  outer  tissues  as  well  as  the  internal  organization. 

Light  and  the  Eyes — ^Light  for  the  eyes  should  be  carefully  gradu- 
ated, so  as  to  prevent  impairment  of  vision.  It  has  the  effect,  if  profuse, 
of  rendering  the  eyes  sensitive,  so  that  they  cannot  bear  the  effects  of 
even  subdued  daylight  without  pain. 

Colored  Light — Many  advantages  are  claimed  for  colored  light.  Blue 
and  green  lights  are  preferable  to  orange,  yellow  or  red  for  the  eyes. 


CONTAGION.  ^35 

Certain  of  the  colored  lights  act  beneficially  on  animal  and  vegetable 
growths,  and  have  a  great  influence  in  hastening  the  cTires  of  certain 
diseases. 

Electricity. — Electrical  conditions  of  the  atmosphere  have  a  direct 
effect  on  the  human  system.  On  the  approach  of  a  thunder  storm,  one 
may  frequently  notice  a  difficulty  of  breathing.  Rheumatics  are  pain- 
fully affected,  neuralgia  is  intensified.  Many  existing  maladies  are  aggra- 
vated by  electrical  conditions. 

Electricity  in  Medicine. — As  a  medical  agent  electricity  has  grovm 
rapidly  in  favor.  As  a  remedy  for  many  nervous  diseases  and  for  pain  the 
galvanic  battery  has  come  into  quite  general  use.  It  is  a  clean,  con- 
venient and  safe  remedy.  It  is  also  economical,  for  the  cost  of  an  electri- 
cal machine  is  within  the  means  of  most  every  one,  and  it  can  be  self- 
operated.     For  the  X-ray  consult  index. 

Climate,  Soil  and  Health. — It  is  not  alone  in  temperature  that  climates 
differ  from  one  another,  and  are  endowed  with  the  power  to  check  or 
engender  diseases.  Into  its  influences  on  the  human  body  must  enter  all 
the  manifestations  of  humidity,  tempest,  fog,  dew  and  wind  directions. 
Diseases  Affected  by  Climate — Among  the  diseases  favorably  affected 
by  a  change  of  climate  are  consimiption,  bronchial  affections,  diseases  of 
the  throat,  asthma,  chronic  gout  and  rheumatism,  dyspepsia,  kidney  affec- 
tions, especially  Bright's  disease,  and  neuralgia.  The  advantages  of  a 
climate  where  sea  air  abounds,  or  where  the  air  is  rarefied  and  dry,  are 
fully  recognized  by  medical  men. 

Soils — These  affect  health  in  the  most  direct  manner,  and  through 
their  mineral,  animal  and  vegetable  matter,  also  their  air  and  water. 
Diseases  connected  with  moist  soils  are  of  almost  every  type,  rheumatism, 
catarrh  and  typhoid  being  most  general.  Moist  soils  are  favorite  breeding 
places  for  germs  affecting  health,  and  drainage  systems  should  be  made 
as  perfect  as  possible. 

Contagion — The  siibject  of  contagion  is  one  of  popular  notoriety  and 
apprehensiom  Certain  receptive  conditions,  or  a  predisposition,  the 
nature  of  which  is  as  yet  unknown,  exist  in  individuals,  which  appear 
essential  to  the  development  of  the  specific  poisons,  and  the  establishment 
of  the  disease.  An  immunity  against  the  repetition  of  a  malady  is  gen- 
erally conferred  by  one  attack  of  a  contagious  disease.  Thiv;  safety  has 
been  proved  real  upon  an  enoi-mous  scale  in  regard  to  small-pox,  and,  in 
relation  to  tlie  other  contagious  disorders,  a  belief  in  such  immunity  from 
second  attacks  is  founded  upon  very  extended  observation ;  but  the  protec- 


236  OtTTWAED  ENEMIES  OE   HEALTH. 

tion  acquired  hy  a  first  attack  of  any  of  tlicsc  diseases  is  of  no  avail  against 
the  rest.  Measles,  for  instance,  renders  the  human  body  proof,  as  a  rule, 
against  measles,  but  leaves  it  as  open  to  small-pox  as  before,  and  so  on 
•with  all  the  rest. 

Morbid  Poisons. — With  regard  to  the  co-operative  effect  of  fermenta- 
tion, putrescence  or  decomposition  there  is  some  reason  to  believe  that 
it  may  quicken  the  activity  or  facilitate  the  development  of  specific 
morbid  poisons  in  the  way  of  a  predisposing  cause  to  their  reproduction. 
There  is  no  small  amount  of  circumstantial  evidence  tending  to  show  that 
conditions  of  this  kind  may  be  thus  favorable  to  the  propagation  of 
specific  diseases,  even  to  the  extent  of  rendering  them  epidemics,  in  con- 
sequence of  the  predisposing  agency  of  putrefying  emanations. 


INDEX  TO  PART  VI  OF  BOOK  III 

Part  VI  of  Book  III  deals  with  the  Germ 
theory  of  disease,  explains  how  germs  propagate  and 
grow  and  the  necessity  of  sanitary  measures  to  pre- 
vent infection  from  them. 


PACE 

Antiquity  of   Germ   Tlieory    237 

Avoidance  of  Germs    243 

Bacteria   238 

Disease  Germs  242 

Germs — 

Antiquity   of    Theory    237 

Avoidance  of   243 

Effect  in   the   Body    241 

Laws    Respecting    237 

Multiplication  of   242 

Of  Scabies  or   Itch    241 

Period  of  Ripening    241 


rAGE 

Rapidity  of   Propagation    243 

Size   of    242 

Itch  Germs    241 

Laws  Respecting  Germs   237,  242 

Multiplication  of  Germs   242,- 

Pasteur  Controversy    237 

Period  of  Germ  Ripening 241 

Rapidity  of  Propagation    243 

Sanitary  Regulations   242 

Size  of  Disease  Germ 242 

Transmission  of  Disease   241 


ILLUSTRATIONS 


Colored    Plate    Showing   Germs   of 
Cholera,     Trichina,      Encysted 


Trichina    and    Cholera,    with    Ex- 
planatory  Notes 239 


237 


PREVENTIVE   MEDICINE. 


PAET  VI. 


THE  GERM-THEORY  OF  DISEASE 

Antiquity  of  the  Theory — In  order  to  make  the  sanitary  precautions 
thus  rendered  advisable  clearly  understood,  it  should  be  explained  in  the 
first  place  that  the  germ-theory  of  disease,  traced  by  some  to  the  celebrated 
Pliny,  vastly  extended  by  the  renowned  botanist,  Linnaeus,  more  than  a 
century  ago,  since  placed  upon  a  scientific  basis,  particularly  through 
the  labors  of  the  celebrated  Pasteur,  of  Paris,  and  Professor  Koch,  of 
Berlin,  to  whom  more  than  to  all  of  their  co-laborers  in  this  important 
field  belongs  the  honor  of  proving  what  had  long  been  suspected,  the  rela- 
tion of  micro-organisms  to  disease,  and  removing  this  subject  from  one 
of  theory  to  one  of  incontestable  fact. 

The  Pasteur  Controversy — Without  relating  in  detail  the  controversy 
that  Pasteur's  announcement  made  in  1857  that  fennentation  and  putre- 
faction were  brought  about  by  specific  ferments  and  that  these  were  com- 
posed of  living  cells,  it  is  sufficient  to  state  that  this  assertion  led  the 
way  for  further  investigation,  discovery  and  proof,  with  the  result  that  the 
micro-organisms  causing  the  diseases  of  relapsing  fever,  discovered  by 
Obermeier ;  that  of  typhoid  fever,  by  Eberth ;  of  diphtheria,  by  Loeffler ; 
of  cholera  and  tuberculosis,  by  Koch ;  of  pneumonia,  by  Friedlander  and 
Frankel,  and  the  origin  of  many  other  diseases  are  now  known  as  the 
result  of  the  labors  of  other  investigators,  whose  claims  were  subjected 
to  the  test  of  the  laws  formulated  by  Koch  before  their  character  was 
established  as  proven. 

Germ  Laws. — In  substance  these  laws  insist  (a),  "that  in  order  to  the 
acceptance  that  a  specific  micro-organism  is  productive  of  disease,  it  must 
be  demonstrated.  (&)  That  it  is  constantly  present  in  the  fluids  or  tissues 
of  the  individual  subject  to  that  disease,  (c)  Its  absence  from  all  other 
diseases,  (d)  Its  isolation,  growth  and  repeated  cultivation  on  proper 
culture  media,  (e)  Its  power  of  reproducing  the  disease  after  inocula- 
tion in  susceptible  animals." 

(239) 


240  BACTEBIA. 

BACTERIA  (See  Adjoining  Plate). 

Bacteria  (Greek,  stick). — Bacteria  are  the  diminutive  organisms  com- 
mon] v  called  Microbes  (Greek,  little).  They  are  visible  only  under  a 
microscope  of  high  magnifying  power. 

Forms — There  are  three  recognized  forms  of  bacteria. 

Spiralus. — 1.  The  spiral,  or  wriggling,  form,  the  only  form  capable 
of  progressive  motion. 

Bacillus. — 2.  The  stick-like,  or  straight  rod-like  form,  incapable  of 
motion. 

Coccus  (berry). — 3.  Very  like,  when  magnified,  a  period  in  print; 
incapable  of  motion. 

The  Plate — Upper  left-hand  object.  The  circle  shows  the  size  of 
the  little  drop  of  liquid  subjected  to  the  microscojic.  It  is  called  the 
microscopic  field.  Within,  in  red,  is  a  magnified  section  of  human  muscle. 
In  its  folds  are  seen,  in  white,  the  encysted  spirala,  called  trichinae  (hairs). 
They  are  found  in  diseased  pork,  and  enter  man  through  the  eating  of  raw 
or  under-cooked  pork.     Thorough  cooking  kills  them. 

The  Plate. — Upper  right-hand  object.  This  is  the  trichina  magnified 
and  more  inature.  It  has  taken  on  the  sf)iral  form,  due  to  growth,  and  is 
consuming  the  muscle  in  which  it  is  embedded. 

The  Plate — Lower  left-hand  object.  This  shows  (1)  in  white,  four 
cells  scraped  off  the  intestines,  in  which  cholera  germs  may  lodge.  The 
little  dark  objects  are  the  spirala  of  cholera.  They  are  found  in  the 
intestinal  canal  and  feces  of  cholera  patients. 

Form — They  are  short,  comma-like  elements,  also  in  the  form  of 
U  and  S,  and  again  long  and  spiral.  They  are  capable  of  motion.  They 
are  cultivated  in  gelatin,  agar-agar,  blood  serum,  potato  and  bouillon. 

The  Plate — Lower  right-hand  object.  This  shows  the  bacillus  of  con- 
sumption (tuberculosis).  It  is  rod-like  in  shape,  slightly  curved,  and 
rounded  at  both  ends.  It  is  not  mobile.  It  may  be  cultivated  in  blood 
serum,  glycerine  and  agar-agar. 


fncjsted  Tnchma  /n//umdnMusc/e 
Double  natural  size. 


Tr/chma  in  Huma/)  Muscle 
Highly  majniFied. 


//?<?  Cho/erd  Germ  and  four /ntestm/  Ce//s 

(Comma  Bacillus) 

Magnified +0  AOODiatneters. 


fhefungoidGrowfh  causing  Consumption 
(BacillusTuberculosis) 
Magnified  to  800  Diameters 


corrmcHT  idie  dy  t  J  Stanley 


GEBM-THEOEY  OF  DISEASE.  241 

Results  of  Germs  in  the  Body — The  results  of  tbe  introduction  of  liv- 
ing organisms  into  the  system  are  local  or  general ;  the  local  disturbances 
are  of  an  iuilanimatorj  nature  caused  hj  mechanical  irritations  arising 
from  the  presence  or  activities  of  the  organisms  and  are  accompanied  by 
proliferation  of  cells  and  the  formation  of  new  tissue. 

General  Disturbances. — The  general  disturbances  may  possibly  result 
from  (a)  nutritive  derangement;  or  (h)  the  organisms  may  cause  innu- 
merable foci  of  local  inflammation,  producing  general  disturbance,  as  for 
example  in  tuberculosis;  or  (c)  by  their  activities  of  growth,  reproduc- 
tion, nutrition,  etc.,  they  may  give  rise  to  poisonous  materials  (ptomaines, 
toxalbumins,  etc.),  which  act  on  the  system  as  any  general  poison,  malaria 
is  probably  an  example  of  this  class. 

Period  of  Germ  Ripening. — The  period  of  incubation  is  the  time  be- 
tween the  introduction  of  the  specific  organism  of  a  disease  (exposure  to 
small-pox  for  example),  and  the  manifestation  of  its  symptoms. 

Increase  of  Symptoms — The  gradual  increment  of  the  symptoms  is 
attributed  to  the  progressive  growth  of  the  millions  of  minute  fungoid 
plants,  whose  period  of  greatest  luxuriance  marks  the  acme  of  the  attack, 
and  the  death  and  destruction  of  which  correspond  to  the  decline  of  the 
disease.  The  contagiousness  of  the  communicable  maladies  is  accounted 
for  very  beautifully  by  the  existence  of  the  immense  number  of  bacteria 
forming  the  true  seeds  of  disease,  constantly  produced,  evolved  from  the 
affected  individual,  and  carried  through  the  air  of  a  room  or  house  either 
alone  or  attached  to  some  of  the  innumerable  epithelial  cells,  which  are 
being  rubbed  off  by  millions  from  the  surface  of  human  bodies. 

Absence  of  Second  Attacks. — The  general  absence  of  second  attacks  is 
admirably  explained  by  the  hypothesis  that  the  parasitic  fungus  on  the 
first  occasion  has  exhausted  all,  or  nearly  all,  of  some  peculiar  (unknown) 
organic  ingredient  in  the  body,  which  is  absolutely  requisite  for  its  sup- 
port, according  to  the  very  same  law  that  will  cause,  as  every  farmer 
knows,  his  wheat  to  fail  if  he  plants  it  repeatedly  in  the  same  ground  and 
neglects  to  secure  a  due  rotation  of  crops. 

Transmission  of  Disease. — Hence,  according  to  this  doctrine,  con- 
tagious diseases  are  conveyed  from  one  person  to  another  by  the  trans- 
planting of  miscroscopically  visible  organisms  and  spores  or  seeds  which 
have  a  separate  vitality  of  their  own,  each  after  its  kind,  and  which  are  to 
be  escaped  just  as  one  would  escape  hordes  of  animal  or  swarms  of  insect 
pests  by  shutting  them  out  or  killing  them  before  they  can  succeed  in 
fastening  upon  human  bodies. 

The  Itch  Germ. — It  is  curious  how  we  have  seen  in  regard  to  small- 
16 


242  GEEM-THEOET  OF  DISEASE. 

pox  and  diphtheria,  etc.,  the  same  old  battle  fought  which  fifty  years 
ago  was  so  strenuously  contested  by  Biett  and  Morgagni  on  the  one  hand, 
and  the  mieroscopists  on  the  other,  in  relation  to  scabies  or  the  itch,  now 
universally  admitted  to  be  caused  by  a  tiny  insect  which  burrows  beneath 
the  hiimau  skin. 

Size  of  Disease  Germs — As  having  an  important  bearing  upon  the 
hygienic  precautions  instituted,  great  benefit  would  probably  result  from 
its  being  imderstood  by  every  man,  woman  and  child  that  the  contagion  of 
small-pox,  scarlet  fever,  typhoid  fever,  yellow  fever,  measles,  diphtheria, 
cholera,  and  so  on,  is  composed  of  exceedingly  minute  forms  of  life,  so 
small  that  25,000  of  them,  placed  end  to  end,  would  measure  less  than  one 
iuch  in  length. 

Multiplication  of  Germs — Bacteria  under  favorable  circumstances 
multiply  with  inconceivable  rapidity,  reproduction  occurring  most  fre- 
quently by  cell  division ;  this  is  technically  known  as  fission,  constriction, 
taking  place  iu  the  centre  of  the  cell,  with  ultimate  separation  at  this 
point  into  two  separate  living  beings ;  from  one  parent  organism,  maturity 
occurring  in  one  hour,  a  progeny  of  fifteen  millions  is  theoretically  possible 
in  twenty-four  hours. 

Nature's  Law — It  is,  however,  probable  that  the  same  law  of  the 
prodigality  of  nature,  exemplified  in  the  spawn  of  the  herring  and  salmon, 
holds  good,  and  not  more  than  one  spore  in  a  thousand,  a  million,  or  a 
hundred  millions,  perhajis,  has  an  opportunity  to  reproduce  its  species. 

Care  Required — As  there  is  no  doiibt  that  the  contagion  of  the  dis- 
eases just  enumerated  may  penetrate  into  your  system  by  the  air  that  is 
breathed,  the  food  that  is  eaten,  and  especially  the  water  that  is  drunk,  it 
is  obvious  that  only  the  most  scrupulous  care  can  save  us  from  these 
extremely  miniite  seeds,  or  insure  their  destruction  after  entrance  into  our 
bodies  is  accomplished.  If  these  germs  were  singly  disseminated,  it  would 
be  almost  impossible  to  avert  constant  infection ;  but  as  they  generally  are 
carried  about  by  winds  or  currents  in  aggregations  of  thousands  or  tens 
of  thousands,  of  course  the  chances  of  imprisoning  them,  or  otherwise 
shielding  ourselves  from  them,  are  largely  increased. 

Sanitary  Regulations — The  obvioTis  deductions  from  these  facts  tend 
to  strengthen  the  urgent  recommendations  of  sanitarians,  that  every  effort 
shoxild  be  made,  first  to  prevent  these  morbific  germs  from  being  let  loose 
upon  the  world;  and  second,  when  they  have  made  their  escape  into 
the  free  air  or  water,  to  destroy  all  these  forms  of  life  that  are  likely 
to  come   iu   contact  with  unprotected   persons — that   is   to   say,    human 


GEKM-TIIKOKY    OF    DISEASE.  243 

beings  from  wliose  bodies  one  crop  of  small-pox  (or  cow  pox)  fungus, 
yellow-fever  bacteria,  relapsing-fever  spirala,  and  so  forth,  has  not  al- 
ready been  raised.  Each  individual  affected  with  small-pox,  scarlet  fever, 
diphtheria,  or  any  other  of  the  diseases  above  mentioned,  is,  according 
to  this  theory,  to  bo  looked  upon  as  a  sort  of  hot-bed  or  forcing-bouse  for 
the  seeds  or  spores  of  that  malady. 

Germs  Grow  Like  Weeds. — Now,  these  germs,  just  like  the  seeds  of 
larger  noxious  weeds,  which,  when  allowed  to  gain  a  foothold  in  fields 
and  gardens  propagate  themselves  with  such  immense  rapidity,  yet  with 
few  exceptions,  have  no  power  to  move  of  their  own  accord,  and  can  only 
develop  if  they  meet  with  air,  moisture,  and  congenial  soil  suited  to  their 
pecidiar  requirements — that  is,  if  a  small-pox  patient  is  shut  up  in  an  air- 
tight room,  so  that  the  seeds  cannot  escape ;  or  if,  whilst  in  the  open  air, 
that  air  is  stagnant,  so  that  no  seeds  are  wafted  away  from  the  immediate 
neighborhood  of  the  individual ;  or  if,  when  carried  along  by  the  wind, 
they  are  blown  away  from  any  human  habitations,  or  are  desiccated  in  a 
dry  atmosphere,  baked  by  the  sim's  rays  or  artificial  heat,  frozen  by  ex- 
treme cold  (as  seems  to  be  the  case  with  yellow-fever  germs)  ;  or,  finally, 
if  they  happen  to  meet  with  no  persons  but  those  who  have  had  small- 
pox or  been  sufiiciently  vaccinated ;  in  other  words,  if  they  do  not  "fall 
upon  good  ground,"  all  this  wealth  of  provision  by  which  nature  tries 
so  hard  to  secure  the  perpetuation  of  the  poisonous  plant  causing  small- 
pox in  our  systems,  becomes  unavailing,  and  her  malevolent  design  against 
our  race,  carried  out  with  such  a  prodigality  of  murderous  weapons, 
utterly  fails. 

Avoidance  of  Germs. — The  germ-theory  of  disease  teaches  that  every 
new  case  of  the  contagious  maladies  is  the  immediate  offspring  of  a  preced- 
ing case,  and  the  direct  result  of  exposure  of  an  unprotected  human 
being  to  the  chance  of  having  the  spores  or  seeds  of  disease  implanted  in 
its  system,  an  exposure  which  it  only  requires  sufficient  knowledge,  suf- 
ficient foresight,  and  sufficient  care  to  avoid. 


PART  VII  OF  BOOK  III 

Treats  of  the  manner  in  which  a  house  should  be 
constructed  to  be  thoroughly  sanitary  and  shows  the 
advantages  derived  from  this  method  of  construction. 


Air,  Composition  of  Soil  Air   248 

Currents  in  Ground-Air   249 

Ground   251 

Motion  of  Soil  Air  249 

In  the   Soil   248 

Sources  of  Polluted  Ground-Air.  .249 

Aspect  of  House    251 

Chimneys   252 

Coal  Gas  in  Dwellings   249 

Composition  of  Soil  Air  248 

Conditions    Necessary    for    a    Healthy 

Home    247 

Construction  of  Walls    252 

Consumption  and  Damp  Soils   248 

Currents   in   Ground-Air    249 

Dangers  of  Made  Ground  250 

Decorations,  Interior   253 

Diseases  Due  to  Damp  Soils 248 

From  Soil  Emanations   250 

Dwelling  Houses,  Healthy   247 

Elimination  of  Soil  Dampness   251 

Ferments  in  Soil   250 

Floor   Coverings    253 

Floors    252 

Foundations  of  House    252 

Furnishings    253 

Ground  Air    251 

Air,  Currents  in    249 

Pores,  Closing  of   249 


Health,  Damp  Soil  Injurious  to   251 

Effect  of  Soil  on    '....248 

Healthy  Dwelling  Houses   247 

Home,  Conditions  Necessary  for.  .247 

House,  Aspect  of   251 

Foundation  of  252 

Interior   Decorations    253 

Furnishings    253 

Made  Ground,  Dangers  of   250 

Polluted  Ground-Air,  Sources  of 249 

Porous  Soils,  Danger  of   250 

Prevention  of  Soil  Emanations   251 

Roof,   The    252 

Site,  Choosing  of   247 

Soil,  Air  in   248 

Air,  Composition  of  248 

Air,  Motion   of   249 

Clean    250 

Consumption  and  Damp  Soils  ....248 

Dampness,  Elimination  of    251 

Damp  Soil  Injurious  to  Heajth  .  .251 

Danger  of  Porous  Soils   250 

Diseases  Due  to  Damp  Soils   ....248 

Effect  of  on  Health  248 

Emanations,  Diseases  from  250 

Emanations,  Prevention  of   251 

Ferments   in    250 

Walls,  Construction  of   252 

Wall  Coverings   253 

Woodwork   253 


245 


PREVENTIVE   MEDICINE. 


PAET  VII. 
HEALTHY  DWELLING  HOUSES 


A  healthy  dwelling  house  is  a  very  potent  factor  in  the  prevention 
of  disease.  If  the  house  or  its  surroundings  be  unsanitary  its  inmates  are 
subject  to  disease  in  many  ways  that  would  not  otherwise  occur,  and  there- 
fore it  is  important  that  the  sanitary  or  unsanitary  condition  of  his  abode 
should  be  considered  by  every  householder. 

SITE,  CONSTRUCTION  AND  INTERNAL  DECORATION. 

Conditions  of  a  Healthy  Home — The  conditions  necessary  to  insure  a 
healthy  habitation  may  be  summarized  as  follows: 

1.  A  site  dry  and  not  malarious,  and  an  aspect  which  gives  light 
and  cheerfulness. 

2.  A  ventilation  that  carries  off  all  respiratory  impurities. 

3.  A  system  of  immediate  and  perfect  sewage  removal  which  shall 
render  it  impossible  that  the  air  shall  be  contaminated  from  excreta. 

4.  A  pure  supply  and  proper  removal  of  water,  by  means  of  which 
perfect  cleanliness  of  all  parts  of.  the  house  can  be  insured. 

5.  A  construction  of  the  house  which  shall  insure  perfect  dryness 
of  the  foundations,  walls  and  roof. 

Choosing  a  Site — The  site  for  a  dwelling  is  rarely  selected  from 
a  consideration  of  the  healthiness  of  the  location,  particularly  in  its  rela- 
tion to  the  conditions  of  the  soil.  Other  considerations,  often  of  an  acci- 
dental character,  more  frequently  determine  the  choice.  And  yet  there 
is  no  more  important  subject  to  be  taken  into  accoimt  in  planning  a  house, 
none  which  demands  a  closer  scrutiny,  in  view  of  its  influence  upon  the 

247 


248  HEALTHY   DWELLING   HOUSES. 

health  of  the  occupants,  than  the  character  of  the  soil  in  ^vhich  its  foun- 
dations arc  laid. 

Effect  of  Soil  on  Health — It  is  only  within  recent  years  that  iniblio 
attention  has  been  generally  directed  to  the  important  relationship  exist- 
ing between  certain  physical  characteristics  of  the  soil  and  health.  The 
ground-air,  ground-water  and  dampness  have  all  been  studied  in  con- 
nection with  their  agency  in  the  production  of  certain  diseases  of  common 
occurrence,  and  important  facts  have  been  arrived  at,  which  are  of  great 
advantage  in  instituting  measures  for  the  preservation  of  health. 

Diseases  Due  to  Damp  Soils. — Paroxysmal  fevers,  typhoid  fever, 
bilious  remittent  fever,  dysentery,  diphtheria  and  cholera  (during  epi- 
demics of  that  disease)  have  all  been  attributed  to  earth  effluvia.  It  is  a 
well-known  fact  that  dampness  of  the  soil  will  cause  catarrhal  affections, 
rheumatism  and  neuralgia. 

Consumption  and  Damp  Soils — It  has  been  clearly  shown  that  damp- 
ness of  the  soil  imder  houses  is  one  of  the  chief  factors  in  the  production 
of  consumption — that  plagiie  of  our  climate  which  destroys  more  lives 
than  any  other  disease.  Typhoid  fever  has  also  been  supposed  to  be 
connected  with  changes  in  the  water  in  the  soil.  A  similar  view  is  held 
with  regard  to  dysentery,  bilious  remittent  fevers  and  cholera.  It  is  thus 
seen  how  potent  are  the  influences  of  certain  conditions  of  the  soil  in 
undermining  health,  and  in  causing  disease,  and  therefore  how  important 
it  is  to  use  every  means  for  protecting  ourselves  against  these  enemies 
of  health. 

The  Air  in  the  Soil. — -All  soils  and  most  rock  formations  are  more 
or  less  porous,  and  are  capable  of  holding  in  their  pores  and  spaces  air 
or  water,  or'  both.  When  air  as  well  as  water  is  present,  the  soil  is  said 
to  be  moist.  Only  the  hardest  rocks  are  free  from  air.  Gravel  and  loose 
sands  are  well  known  to  be  very  porous,  the  latter  containing  often  as 
much  as  half  their  bulk  of  air.  The  amount  of  air  in  some  varieties  of 
soft  sandstones  sometimes  reaches  40  per  cent. 

Composition  of  Soil  Air. — The  composition  of  the  air  in  the  soil  is 
variable,  and  differs  widely  from  that  of  the  free  atmosphere.  Carbonic 
acid  in  variable  quantity  is  usually  one  of  its  constituents.  The  origin 
of  this  gas  is  supposed  to  be  due  to  organic  changes  taking  place  in  the 
soil  itself.  It  cannot  be  derived  from  water  precipitated  from  the  atmos- 
phere, as  the  amount  of  this  gas  in  meteoric  water  is  exceedingly  small. 
JTor  is  it  to  be  sought  for  in  the  ground-water  as  a  source;  but  is  most 
likely  derived  from  the  soil,  and  is  imparted  to  the  ground-water  and 


SITE,    CONSTETTCTION   AND    INTERNAL   DECOEATION.  249 

ground-air  simultaneously,  but  more  freely  to  the  latter  on  account  of 
its  greater  absorbent  capacity. 

Sources  of  Polluted  Ground-Air — The  ground-air  contains  more  or 
less  moisture,  and  is  liable  to  be  contaminated  by  effluvia  and  organic 
matter  arising  from  the  constituents  of  the  soil.  A  frequent  source  of 
ground-air  pollution  in  inhabited  places  is  the  impurities  which  soak 
into  the  soil  from  leaking  cesspools  and  drains,  from  liadly-constructed 
sewers,  from  leaky  gas-mains,  and  from  deposits  of  filth  iipon  the  surface 
of  the  ground. 

Motion  of  Soil  Air — ^It  is  important  to  observe  that  the  air  in  the 
soil  is  in  continual  movement.  This  movement  is  especially  active  in 
dry,  porous  soils.  The  motion  of  the  air  in  the  ground  is  caused  by  press- 
ure of  the  atmosphere  and  wind  against  its  surface ;  by  changes  in  the 
temperature  of  the  lower  strata  of  the  atmosphere  and  of  the  upper  sur- 
face of  the  soil,  by  the  rainfall,  and  by  changes  in  the  level  of  the  ground- 
water ;  and  to  some  extent  by  the  operation  of  the  law  of  diffusion  of  gases. 

Closing  of  Ground-Pores. — At  every  rainfall,  the  pores  of  the  super- 
ficial layers  of  the  ground  are  closed  by  the  inflowing  water,  so  that  the 
upward  escape  of  the  imprisoned  air  is  hindered,  while  the  rise  in  the 
ground-water  exerts  a  pressure  from  the  opposite  direction ;  under  the 
circumstances  the  ground-air  seeks  an  outlet  at  the  point  of  least  resist- 
ance, and  in  many  cases  escapes  into  dwellings — the  more  freely,  the 
more  extended  and  copious  the  rainfall. 

Currents  in  Ground-Air. — A  current  in  the  ground-air  may  be  caused 
by  local  conditions ;  thus,  a  house  artificially  heated,  being  warmer  inside 
than  the  external  air,  will  cause  a  current  of  air  to  enter  it  from  the 
ground  on  which  it  stands.  Any  impurities  in  the  surrounding  soil  may 
find  access  to  the  house  through  this  channel. 

Coal-Gas  in  Dwellings — ISTumerous  instances  have  been  recorded  of 
the  penetration  of  coal-gas  into  dwellings  through  the  pores  of  the  soil 
imder  the  basement  floors,  the  entrance  of  the  gas  being  facilitated  by 
the  activity  in  the  current  of  ground-air  caused  by  tlie  heated  house.  Ill- 
health,  and  even  death,  has  been  caused  by  gas  escaping  into  houses  in 
this  manner.  In  the  same  way  the  air  made  noxious  by  the  oozings  from 
cesspools  and  broken  drains,  and  by  foul  matters  contained  in  the  soil, 
may  gain  entrance  through  the  foundation  floors. 


250  HEALTirV   DWELMNQ    IIOTJSES. 


FEATURES  OF  A  HEAITHY  SITE. 

A  Clean,  Natural  Soil. — A  clean,  iiatiir.al  soil,  such  as  is  free  as-  pos- 
sible from  those  organic  changes  or  jirocesses  which  cause  unhealthy 
emanations,  should  be  the  prime  object  in  changing  the  location  of  a 
dwelling.  ISTo  effort  should  be  spared  in  improving  the  healthiness  of 
a  site.  This  may  be  accomplished  by  keeping  the  soil  clean  through  effi- 
cient drainage,  abolition  of  cesspools  and  other  sources  of  filth-impreg- 
nation, and  an  abundant  source  of  water  for  maintaining  cleanliness  in 
all  parts  of  the  house.  And  further,  by  making  the  ground  floors  and 
walls,  as  far  as  possible,  impermeable  to  air. 

Dangers  of  Made-Groimd — "IMade-ground"  is  to  be  looked  upon  with 
the  greatest  suspicion.  Such  a  soil,  generally  composed  of  the  refuse 
of  a  town,  is  necessarily  very  impure,  and  a  house  built  upon  it  is  liable 
to  be  unhealthy.  A  process  of  purification  by  oxidization  and  the  influence 
of  rain  naturally  takes  place  in  the  course  of  time,  but  the  uncertainty 
of  the  result  should  always  be  determined  by  an  examination  of  the 
ground.     It  is,  however,  best  to  avoid  such  a  location  altogether. 

Of  Porous  Soils. — Porous  soils,  such  as  those  composed  of  gravel  or 
rubble,  are  generally  supposed  to  be  healthy,  but  the  assumption  is  not 
to  be  taken  without  qualification.  The  great  facility  which  they  afford 
for  the  circulation  of  air,  and,  through  this  medium,  of  conducting  im- 
purities for  a  long  distance,  aided  by  the  suction  power  of  the  house, 
makes  it  essential  that  such  soils,  in  order  to  be  healthy,  should  be  free 
from  noxioiis  effluvia  and  deposits  of  animal  or  vegetable  matter. 

Danger  of  Porous  Soils. — Dry,  porous  soils,  otherwise  unobjectionable, 
may  be  the  source  of  morbid  exhalations.  The  ground  in  inhabited 
places,  and  even  about  isolated  dwellings,  often  becomes  impregnated 
with  filth  from  sewers,  broken  drains,  cesspools,  and  refuse  heaps,  which 
imdergoes  decomposition  and  gives  rise  to  noxious  gases  which  are  danger- 
ous to  health  in  proportion  to  the  degree  of  concentration. 

Ferments  in  Soil. — Such  a  filth-sodden  soil  is,  moreover,  a  convenient 
nidus  for  the  production  of  those  morbific  ferments  which  seem  to  be 
connected  with  certain  palpable  organisms,  which  are  looked  upon  as  very 
important  agents  in  the  production  of  some  of  the  common  diseases  that 
afflict  hiimanity. 

Diseases  from  Soil  Emanations. — Amonc;  the  diseases  which  have  been 
attributed  to  emanations  from  the  soil  may  be  mentioned  typhoid  fever— 


PEEVENTION    OF    SOIL   EXHALATIONS.  251 

that  scourge  of  the  country  as  well  as  the  city — cholera,  fevers,  dysentery 
and  diphtheria. 

To  Prevent  Soil  Emanations. — As  it  is  impossihle  to  prevent  the  cir- 
culation of  the  air  in  the  ground,  structural  devices  must  be  employed 
to  keep  the  soil-exhalations  from  rising  uj)  into  the  house.  This  is  best 
accomplished  by  covering  the  entire  site  of  the  house  with  a  layer  of 
cement,  concrete,  asphalt  or  some  other  impei-vious  material.  A  layer 
of  concrete  at  least  six  inches  deep,  well  rammed  and  well  grouted  with 
liquid  cement,  and  made  smooth  upon  the  surface,  makes  a  most  satis- 
factory barrier  to  the  ground-air  and  dampness. 


PREVENTION  OF  SOIL  EXHALATIONS. 

Ground  Air. — Every  house  should  be  protected  from  access  of  ground 
air.  The  selection  of  a  proper  site  has  much  to  do  with  this,  but  not  all, 
for  since  it  is  impossible  to  prevent  the  circulation  of  ground  air,  certain 
devices  must  be  employed  to  keep  soil  exhalations  from  rising  into  the 
house. 

The  Best  Device The  best  device  for  this  is  to  cover  the  entire  site 

with  a  layer  of  cement,  concrete,  asphalt  or  some  impervious  material.  A 
layer  of  concrete  six  inches  deep,  well  rammed  and  grouted  with  liquid 
cement,  is  a  most  satisfactory  barrier  to  ground  air  and  dampness.  As- 
phalt over  concrete  also  affords  an  excellent  barrier.  Such  a  floor  has  the 
advantage  of  being  free  from  cracks  and  holes  which  harbor  vermin. 

Dampness  of  Soil  Injurious. — Dampness  of  soil  is  dangerous  to  health. 
A  dry,  porous  soil  with  possibilities  of  natural  drainage  will  be  found  to  be 
salubrious.  Elevation  of  site  is  an  indication  of  the  presence  of  this  con- 
dition. A  damp  condition  of  soil  may  be  kept  up  by  injudicious  planting 
of  trees  and  shrubs  too  near  the  house  or  by  neglect  in  diverting  drainage 
to  some  distant  outlet  and  thereby  preventing  its  absorption  by  the  soil. 

House  Aspect In  choosing  a  house  site  preference  should  always  bo 

given  to  the  aspect  or  exposure  which  gives  most  light  and  cheerfulness, 
insures  free  circulation  of  air  without  being  subjected  to  violent  gusts  of 
weather  and  is  defended  as  far  as  possible  from  ISTorth  and  East  winds ;  a 
location  free  from  mists  and  fogs,  sudden  shiftings  of  temperature  and 
malarial  and  other  injurious  influences. 

Removing  Soil  Dampness. — For  a  building  to  be  healthy  the  subsoil 
water  should  never  be  allowed  to  rise  to  the  level  of  the  found utiona.     To 


252  HEALTHY   DWELI.ING    HOUSES, 

prevent  this  ordinary  land  drainage  pipes  should  be  so  laid  as  to  carry  off 
the  subsoil  waters  into  some  sewer  or  other  outlet. 

Foundations — Foundation  walls  should  be  composed  of  the  best  ma- 
terials and  to  prevent  moisture  being  absorbed  by  the  materials,  thereby 
injuring  the  walls  and  timbers  and  rendering  the  atmosj)here  within 
unhealthy,  a  damp-proof  course  of  some  impervious  substance  like  cement 
should  be  built  in  the  wall  just  above  the  surface  of  the  ground. 

External  Walls. — The  walls  of  a  house  are  sometimes  rendered  damp 
by  exposure  to  continued  ^7ct  weather.  Various  means  have  been  em- 
ployed for  protecting  the  outside  walls  in  exposed  positions.  Smooth,  hard 
bricks,  glazed  bricks,  slate,  cement,  weatherboards  and  tin  have  all  been 
satisfactorily  used  for  this  purpose  and  under  a  variety  of  circumstances. 
Some  walls  are  improved  by  a  coating  of  good  paint,  but  its  frequent  re- 
newal makes  it  expensive.  Hollow  walls  are  not  infrequently  constructed 
as  a  protection  against  dampness.  Two  parallel  walls  are  constructed  with 
a  space  between  them  three  or  four  inches  wide  and  joined  together  with 
bonding-ties  of  iron  or  stoneware.  By  this  plan  not  only  is  dampness  ex- 
cluded but  a  more  equable  temperature  is  maintained  in  the  house. 

Construction  of  External  Walls. — ^Whatever  be  the  material  chosen  for 
the  external  walls  it  should  be  of  the  best  quality  and  well  put  together. 
If  stone  or  brick  be  chosen,  and  the  latter  is  always  preferable  as  being 
fire-])roof,  the  laying  should  be  done  in  well-tempered  mortar  or  cement, 
and  the  wall  should  be  of  sufficient  thickness  to  insure  stability,  keep  out 
weather  and  protect  the  air  of  the  house  from  the  influence  of  sudden 
^veather  changes. 

CMmneys. — To  insure  safety  against  fires  the  brick  work  of  chimneys 
and  fire-places  ^ould  be  at  least  nine  inches  thick,  and  no  wooden  plugs  or 
bricks  should  ever  be  inserted  in  it  lest  they  become  charred  and  ignite 
and  set  the  house  on  fire.  Terra-cotta  linings  to  chimneys  are  a  source  of 
safety  and  cleanliness.  So  far  as  possible  chimneys  should  be  straight  and 
have  a  smooth  interior  so  as  to  facilitate  the  dravight. 

The  Roof — A  good  roof  is  an  important  part  of  a  sanitary  house.  If 
not  properly  constructed  it  is  a  constant  source  of  annoyance.  Slate,  tiles, 
zinc,  copper,  lead,  tin  and  shingles  all  make  substantial  roofs.  Tarred  felt 
and  gi-avel  compositions  are  not  to  be  recommended  except  for  temporary 
structures.  Metal  roofs  require  but  little  slope,  but  the  slope  of  slate, 
shingle  or  tile  roofs  should,  be  steep.  Great  care  should  be  taken  in  the 
arrangement  and  making  of  gutters,  spouting  and  pipes. 

Floors. — These  should  be  of  well-seasoned  lumber  and  laid  so  aa  to 


PEEVENTION   OF  SOIL   EXHALATIONS.  253 

present  a  smooth,  even  surface,  free  from  cracks.  The  plowed  and  grooved 
floor  and  the  doweled  floor  have  great  advantages.  Fire-proof  floors  are 
desirable  but  not  adapted  to  ordinary  dwellings.  Basement  floors  should 
be  of  concrete. 

Floor  Coverings — The  inlaid  flool-  composed  of  different  woods 
and  known  as  jjarquetry  is  ornamental  and  very  effective  when  it  is  in- 
tended to  dispense  with  carpets.  Carpets  were  formerly  much  more  used 
as  floor  coverings  than  at  present.  They  are  not  a  sanitary  covering  on  ac- 
count of  their  susceptibility  to  collect  dust  and  dirt  and  they  are  difiicult  to 
remove  and  shake.  The  present  fashion  of  abandoning  the  closely  fitting 
carpets  and  substituting  parquetry  rugs  and  square  carpets  on  stained  or 
varnished  floors  is  an  important  step  toward  effecting  improvement  in  the 
sanitary  condition  of  dwellings. 

Wall  Coverings — For  cottages  and  inexpensive  dwellings  no  wall 
covering  is  lietter  or  healthier  than  lime  whitewash.  It  may  be  ren- 
dered artistic  by  coloring,  and  can  be  renewed  readily  and  cheaply.  Paint 
answers  as  an  excellent  wall  covering.  It  produces  a  smooth,  hard,  non- 
absorbent  surface  which  can  be  washed  when  necessary.  Paper  is  most 
used  at  present  as  a  wall  covering,  but  it  is  doubtful  if  it  is  a  good  sanitary 
covering,  as  it  is  absorbent  of  moisture  and  is  very  apt  to  become  saturated 
with  impiirities  in  the  heated  air  of  rooms.  Moreover,  many  wall  papers 
are  dangerous  from  the  fact  that  some  of  their  colors,  especially  the 
green,  are  derived  from  poisonous  substances. 

Woodwork — The  woodwork  about  the  house  may  be  stained  and 
varnished,  or  oiled  and  polished,  or  painted.  Natural  wood,  oiled  and  pol- 
ished, or  varnished,  the  pores  first  having  been  "filled,"  makes  a  most  de- 
sirable finish,  and  is  rapidly  coming  into  general  use.  Whatever  may  be 
the  choice  in  this  respect  it  is  important  that  the  materials  used  shall,  as  far 
as  possible,  be  impervious,  and  so  applied  as  to  present  a  smooth,  even 
surface  that  will  repel  dust  and  dirt  and  admit  of  being  easily  cleaned. 
This  recommendation  applies  with  equal  force  to  all  the  interior  finishing 
of  the  house. 

Internal  Decorations  and  Furnishings. — The  internal  decoration  and 
fittings  or  furnishing  of  the  house  may  exert  no  inconsiderable  influence 
on  health,  and  it  is  therefore  important  tliat  tliey  conform,  as  far  as  pos- 
sible, to  the  principles  of  sanitation,  so  as  to  conduce  to  the  health  as  well 
as  the  comfort  of  the  occupants.  It  is  clearly  evident  that  all  furniture, 
wlilch,  by  its  excessive  decoration  or  peculiar  construction,  collects  and  con- 
ceals dust  and  dirt  that  cannot  be  easily  detected  and  removed ;  all  heavy 


254  HEALTHY  DWELLING   HOUSES. 

drapery,  so  commonly  hung  in  profusion  about  living  and  sleeping  apart- 
nicnls,  which  cannot  be  cleaned  with  facility  and  which  excludes  light  and 
air;  all  over-ornamentation  of  ceilings  and  cornices  by  elaborate  mouldings 
which  defy  all  attempts  at  cleansing ;  the  so-called  artistic  furniture  loaded 
down  with  ornaments  of  china  and  glass,  and  "what-not,"'  which  furnish 
so  many  hiding  jilaccs  for  the  ever-present  dust;  all  these  are,  to  a  great 
extent,  objectionable  and  unhealthy. 


PART  VIII  OF  BOOK  III 

Shows  how  necessary  to  health  it  is  to  remove  all 
refuse  matter,  solid  and  liquid,  from  dwellings  and 
their  vicinity. 


Air  Pollution,   Sources  of   257 

Cleanliness,  Safety  in   257 

Closet,       Construction       of      Sanitary- 
Closet    258 

Sanitary    257 

System,  Earth    258 

Disease,  Filth  as  a  Cause  of 257 

Drainage,  House   257 

Drains,   Flushing   of    258 

Dry  System  of  Removing  Excreta  ...258 

Earth-Closet  System,  The   258 

Filth  as  a  Cause  of  Disease  257   , 


House  Drainage   257 

Drains,  Flushing  of   25S 

Polluted  Air,   Sources   of    257 

Water,   Sources  of   257 

Rain-Water  Leaders    258 

Safety  in  Cleanliness   257 

Sanitary  Closets   257 

Closet,   Construction  of    258 

System  of  Removing  Excreta,  Dry   ..258 
Water  Pollution,  Sources  of  257 


255 


PREVENTIVE   MEDICINE 


PAET  VIII. 
SANITARY  CLOSETS 


The  thorough  removal  of  refuse  matter,  solid  and  liquid,  from  build- 
ings and  their  vicinity,  is  indispensable  to  healthy  life.  Neglect  of  this 
is  a  cause  of  a  vast  number  of  preventable  diseases. 

Why  Filth  Produces  Disease — Accumulations  of  filth  about  houses 
taints  air,  water  and  soil.  Septic  particles,  or  ferments,  given  off  in  the 
putrefaction  of  organic  matter,  evolve  the  seeds  of  many  diseases. 
Typhoid  and  enteric  fevers  are  thus  engendered.  Privies  and  privy  drain- 
age and  soakage  have  given  rise  to  typhoid  ei^idemics.  Cholera,  dysentery 
and  allied  diseases  spring  from  the  same  source.  Many  other  diseases 
owe  their  origin  to  filth  poisons.  Many  suppose  that  consumption  may  be 
due  to  filth  particles.  Filth  is  the  breeding  place  of  the  germs  of  diphtheria 
and  other  fatal  diseases. 

Safety  in  Cleanliness. — All  refuse  matter  calculated  to  poison  air, 
water  or  soil  near  a  dwelling  should  be  sedulously  removed.  This  neces- 
sity exists  everywhere,  in  city  as  well  as  in  country. 

Sources  of  Air  and  Water  Pollution — Nuisances  traceable  to  air  and 
water  pollution  are: 

1.  Defects  of  public  sewerage. 

2.  Defects  of  house  drainage. 

3.  Faults  of  cess-pool  arrangement.  No  cess-pool  should  exist  as  a 
simple  hole  in  the  ground.  It  should  be  walled  or  bricked  dry,  ami 
the  bottom  laid  similarly.  It  should  be  frequently  cleansed.  No  wells 
should  be  near  it. 

House  Drainage — Every  house  drain  should  insure  the  removal  of  all 
liquid  refuse,  waste-water  and  fecal  matter,  without  leakage.  The  pipes 
should  be  of  iron  or  earthen  ware,  for  at  least  eight  or  ten  feet  distant 
from  the  house ;  but  if  a  spring  or  well  be  near  the  piping  should  continue 
far  beyond  it.  All  pipes  should  be  laid  in  a  bed  of  clay,  and  the  joints 
firmly  cemented.  Cement  beds  for  pipes  are  the  best. 
17  257 


258  SANITAKY  CLOSETS. 

Flushing  of  House-Drains — All  house-drains  should  be  occasionally 
flushed  by  pouring  large  bodies  of  -water  into  them.  Tield's  flush  tank 
is  used  for  the  purpose  of  flushing  drains  in  the  country. 

Rain-Water  Leaders. — A  convenient  plan  of  disposing  of  rain  water 
is  to  pass  it  through  the  drain  pipes.  This  affords  an  excellent  flush,  but 
care  must  be  taken  against  freezing  in  winter ;  all  conductors  of  rain  water 
should  be  kept  outside  the  bouse,  lest  the  back  gases  should  enter  the 
house. 

Dry  System  of  Uemoving  Excreta — The  dry  system  is  adapted  to  towns 
and  villages  and  to  single  cottages.  It  consists  in  the  admixture  of  dried 
earth,  coal  ashes,  or  other  dried  refuse,  with  the  excrement  in  sufficient 
quantity  to  absorb  and  reduce  it  to  an  inodorous  form.  The  absorbent 
material  must  be  perfectly  dry,  and  must  be  applied  immediately,  and  in 
sufScient  quantity  to  cover  the  excretions  and  remove  all  fluidity.  All 
slops  and  sink  water  and  solid  matter  must  be  carefully  excluded.  In 
rural  districts  this  plan  can  be  made  very  satisfactory,  but  in  towns  it  is 
seldom  that  the  removal  takes  place  sufficiently  often  to  meet  the  require- 
ments of  the  case.  The  receptacles  should  be  made  of  impervious  mate- 
rials, and  the  closet  should  be  located  either  out  of  doors,  or  in  an  isolated 
part  of  the  building,  or  in  an  apartment  projecting  from  the  house.  The 
apartment  should  be  well  ventilated. 

The  Earth-Closet  System.- — lloule's  earth-closet  system  comes  under 
the  head  of  the  dry-removal  systems,  and  is  the  plan  with  which  the  piiblic 
is  most  familiar.  On  account  of  the  absorbing  and  deodorizing  qualities 
of  dried  earth,  this  substance  is  selected  for  use  in  closets,  especially  within 
the  house.  The  original  apparatus,  designed  by  Mr.  Moule,  consists  of 
a  wooden  box  divided  into  two  main  compartments.  The  lower  one  contains 
a  receptacle  or  pail  for  the  sewage,  and  the  njiper  one  the  reservoir  or 
hopper  from  which  the  dried  earth  is  supplied  in  requisite  quantity  when- 
ever the  closet  is  used.  The  hopper  in  the  upper  part  of  the  apparatus 
is  capable  of  holding  an  ordinary  coal-scuttle  full  of  earth.  A  plug  is 
attached  to  its  outlet,  and  is  operated  by  a  lever  connected  with  a  handle. 
Beneath  the  seat  is  a  guard,  which  directs  the  dried  earth  into  the  pail 
without  allowing  any  of  it  to  escape  at  the  sides. 

Construction  of  Sanitary  Closet. —  (1)  A  concrete  bin,  six  feet  long, 
three  feet  deep  and  two  and  one-half  feet  wide  in  measiirements,  divided 
into  three  compartments  of  equal  size  by  concrete  partitions,  the  first  of 
which  is  built  so  as  to  leave  a  six-inch  sjjace  at  the  bottom  and  the  secoiid 
a  six-inch  space  at  the  top. 


PART  I  OF  BOOK  IV 

Treats  of  the  eruptive  diseases  ;  their  classification, 
prevention,  symptoms  and  treatment. 


Adults,    Doses   for    264 

Ague    322 

Treatment  of   324 

Anthrax    344 

Causes  of   344 

Intestinal    34S 

Malignant    345 

Treatment   of    345 

Bacilli,   Means  of  Conveying   278 

Tj'phoid    278 

Bed  Sores,  Treatment  of  286 

Black  Vomit   234 

Blood   Poison   347 

Cause   of    347 

Pus    348 

Treatment   of   348 

Brcak-bonc  Fever  274 

Bubonic  Plague   301 

Cause  of    301 

Treatment  of    302 

Caclienia,  Malarial   320 

Ccrcbro-Spinal  Meningitis   28S 

Change  of   Medicines    265 

Children,  Doses  for  264 

Chill,    Congestive    326 

Cholera,    Asiatic    32S 

Cholera   Morbus    327 

Causes   of    327 

Treatment  of    328 

Chronic  Malaria    320 

Treatment  of   321 

Classification   of  Disease    261 

Complicated   Dispases    263 

Congestive  Chill    326 

Constitutional  Diseases  262 

Continued  Fever   325 

Continued  Fever,  Protracted  Simple.. 293 

Cow-pox     272 

Dengue    274 

Diphtheria    335 

Cause  of   3.33 

Complications  in   337 

25  a 


Laryngeal   S37 

Nasal    336 

Pharyngeal    335 

Prevention    of    338 

Treatment  in   339 

Diseases,   Classification  of   261 

Doses  for  Adults  264 

For  Children   264 

How  to  Graduate  264 

Dosing,   Care  in    263 

Edema     34S 

Emetics,  Doses  of   264 

Ephe  mcral  Fever    293 

Causes   of    293 

Treatment  of   293 

Eruptive  Diseases   261 

Erysipelas    346 

Causes   of    346 

Treatment  of  347 

Estivo-Autumnal   Fever   320 

Farcy     343 

Febricula    293 

Febris  Recurrens   291 

Fever,   Break-bone    274 

Cerebro-Spinal   287 

Continued 325 

Ephemeral    293 

Estivo-Autumnal    320 

Gibraltar 294 

Intermittent 322 

Malarial    316 

Perincenis  Malarial   320 

Pernicious  Malarial    326 

Protracted  Simple  Continued  ....293 

Purpuric    288 

Relapsing     291 

Remittent     325 

Sailors'    294 

Spotted    287 

Typhoid    277 

Typhus    275 

Yellow     294 


260 


IimEX   TO   PART   I   OF    BOOK    IV. 


German   Measles    273 

Gibraltar  Fever   294 

Glanders     343 

Glanders,  Cause  of    343 

Treatment  of   344 

Graduation  of  Doses  264 

Grippe,  La   342 

Hookworm   Disease    309 

Cause  of  309 

Treatment  of   311 

Influenza    342 

Causes   of    342 

Treatment  of  343 

Intermittent  Fever    322 

Intestinal  Anthrax    345 

Irregular    Fever    325 

La  Grippe   342 

Laryngeal   Diphtheria    337 

Malaria,  Chronic   320 

Malarial  Cachenia   320 

Malarial  Fever,  Perincenis   320 

Malarial  Fever,  Pernicious   326 

Malarial  Fevers   316 

Cause  of    316 

Treatment  of    320 

^Malignant   Anthrax    345 

Pustule   344 

Measles,   German    273 

Medicines,  Change  of   265 

Meningitis,   Cerebro-Spinal    28? 

Nasal  Diphtheria   336 

Opiates,  Doses  of  264 

Pellagra    314 

Perincenis  Malarial   Fever    ,....320 

Perincenis    Malarial    Fever,    Symp- 
toms of  320 

Pernicious  Malarial  Fever   326 

Treatment  of   326 

Pharyngeal   Diphtheria         335 

Plague,   Bubonic    301 

Protracted   Simple  Continued   Fever.  .293 

Causes   of    293 

Treatment,  of  294 


Purpuric  Fever   288 

Pus  Blood  Poison   348 

Pyemia   348 

Causes  of    348 

Treatment  of   349 

Relapsing   Fever    291 

Cause  of  291 

Treatment  of   293 

Remittent  Fever    325 

Cause  of   326 

Treatment  of   326 

Rotheln  273 

Rubella    273 

Sailors'  Fever   294 

St.  Anthony's  Fire 346 

Septicemia    347 

Simple  Continued  Fever,  Protracted.  .293 

Sleeping  Sickness   306 

Cause  of  306 

Treatment  of   308 

Small-pox    26s 

Cause  of    265 

Nursing  in   270 

Treatment  of   268 

Vaccination  in    270 

Varieties   of    266 

Spotted  Fever    287 

Causes  of   287 

Treatment  of   289 

Typhoid  Bacilli    278 

Typhoid  Fever  277 

Nursing   in    285 

Treatment  of   282 

Walking   286 

Tj-phus  Fever  27s 

Vaccina    272 

Vaccination  as  a  Preventive  of  Small- 
pox     270 

Variola   265 

Walking  Typhoid   286 

Wool  Sorter's  Disease   345 

Yellow  Fever   294 

Treatment   of   300 


ILLUSTRATIONS 


The  Cholera  Germ 328 

Hookworms 310 

Small-pox    266,  268,  269 


Vaccination    270 

Varioloid    267 

Yellow  Fever  Mosquito , 295 


Book  IV 


CURATIVE    MEDICINE 


PAET  I. 
THE  ERUPTIVE  DISEASES 

The  Plan  and  Scope  of  the  Subject. — In  this  part  of  the  work,  the 
author  proposes  to  give  an  outline  of  the  natural  history  of  each  disease, 
advice  as  to  the  modes  of  preventing  its  onset  "when  threatened,  recom- 
mendations as  to  its  hygienic  management,  hints  as  to  its  probable  course, 
fatality,  and  ultimate  results  upon  the  system,  if  recovery  takes  place,  and 
finally  suggestions  in  regard  to  its  medical  treatment. 

Home  Value  of  the  Book — As  already  advised,  the  most  skillful  physi- 
cian who  can  be  procured  should  be  called  in  to  treat  disease ;  but  in  the 
emergency,  imtil  he  arrives,  much  can  be  done  in  accordance  with  the 
directions  here  given  to  allay  the  sufferings  of  the  patient,  to  place  him  in 
a  more  favorable  position  for  speedy  recovery,  and,  above  all,  to  prevent 
the  calamity  which  has  befallen  him  from  becoming  aggravated  before  the 
doctor  comes,  through  want  of  proper  care. 

Manner  of  Treatment. — Since  a  large  proportion  of  the  "ills  which 
flesh  is  heir  to"  are  rarely  seen  in  this  country,  and  have  therefore  but 
little  importance  to  inhabitants  of  the  United  States,  except  as  matters  of 
curiosity,  it  is  proposed  to  give  very  brief  notices  of  these  infrequent 
maladies,  in  order  to  economize  space  for  a  fuller  account  of  those  prev- 
alent diseases  which,  sometimes  in  their  lives,  will,  alas,  personally  in- 
terest a  majority  of  the  readers  of  this  book. 

THE  CLASSIFICATION  OF  DISEASE. 

Among  the  almost  innumerable  methods  of  classifying  diseases  which 
afflict  the  human  family,  one  of  the  latest,  and  probably  the  best,  is  that 
devised  by  the  Royal  College  of  Physicians  of  England,  and  adopted  by 

(261) 


262  TllK   ERUPTIVE   DISEASES. 

law  as  tlie  basis  for  all  those  statistical  reports  relating  to  medical  subjects 
of  wliicli  tlio  British  nation  is  justly  entitled  to  be  proud.  This,  with 
some  iminiportant  variations,  is  the  system  adhered  to  in  the  present 
section. 

English  Names  for  Diseases — The  plan  of  this  nomenclature  is  to  give 
an  English  name  to  the  disease,  employing  the  terms  in  popular  use  when- 
ever they  are  not  absolutely  inaccurate,  and  to  use  only  one  word,  or  as 
few  words  as  possible,  in  naming  a  disease.  Definitions  are  attached  to  the 
English  names  in  certain  instances  only,  that  is  in  cases  where  there  might 
otherwise  be  some  ambiguity  in  the  signification  of  the  title.  The  classi- 
fication of  diseases  thus  designated  is  based  on  their  anatomical  seat  in  the 
human  body,  the  division  being  first  into  general  diseases  and  local  diseases. 

General  Diseases. — The  general  diseases  are  those  which  affect  the 
whole  frame,  and  are  subdivided  into  two  sections.  The  first  compre- 
hends those  disorders  which  appear  to  involve  a  morbid  state  of  the  blood, 
and  for  the  most  part  present  the  following  characteristics.  They  run  a 
definite  course,  are  attended  with  fever,  and  frequently  with  eruptions  on 
the  skin ;  are  more  or  less  readily  communicable  from  person  to  person,  and 
possess  the  singular  and  important  property  of  generally  protecting  those 
who  suffer  with  them  from  a  second  attack;  they  are  apt  to  occur  as  epi- 
demics. Small-pox  is  a  good  example  of  this  group,  and  in  our  ceaseless 
combat  with  disease  it  is  with  disorders  of  this  section  that  hygiene  and 
preventive  medicine  have  won  their  grandest  triumphs  and  accomplished 
their  most  beneficent  work. 

Constitutional  Diseases — The  next  of  the  general  diseases  comprises 
for  the  most  part  maladies  which  are  apt  to  invade  different  parts  of  the 
same  body,  simultaneously  or  in  succession.  These  disorders  are  some- 
times spoken  of  as  constitutional  diseases,  and  they  often  manifest  a 
tendency  to  transmission  by  inheritance.  Gout  and  rheumatism  furnish 
good  illustrations  of  this  type  of  disease. 

Diseases  of  the  Organs. — The  second  class,  that  of  local  diseases,  com- 
prehends all  those  which  affect  the  structure  of  special  organs,  or  par- 
ticular parts  of  the  human  body,  leading  to  marked  disturbance  of  their 
functions.  Diseases  of  the  eye,  such  as  cataract,  and  local  inflammations, 
such  as  pneumonia  or  inflammation  of  the  lungs,  exemjilify  the  characters 
of  this  group.  Owing  to  the  wonderfully  close  association  and  sympathy 
between  all  the  different  parts  of  the  human  frame,  no  one  organ  can 
suffer  alone,  and  hence  with  the  local  diseases  constitutional  disturbances, 
such  as  fever,  generally  arise,  and  may  totally  mislead  an  inexperienced 
observero 


CARE  IN   DOSING.  263 

Hecognition  of  Local  Diseases. — The  recognition  of  local  disease  in 
obscure  cases  is  often,  indeed,  one  of  the  most  difficult  problems  a  physi- 
cian can  be  called  upon  to  solve.  Commonly  complaint  of  pain  in  some 
particular  part  directs  attention  to  that  spot  as  the  seat  of  primary  dis- 
turbance, and  leads  to  its  thorough  examination,  which  should  be  made 
with  the  aid  of  all  the  mechanical  appliances,  such  as  the  stethoscope,  the 
microscope,  the  thermometer,  and  so  forth,  which  medical  science  has 
placed  at  our  disposal.  It  is  only  when  after  all  these  means  are  exhausted, 
in  a  vain  effort  to  detect  local  disease  at  the  seat  of  pain  or  of  pronounced 
discomfort,  sufficient  to  account  for  that  disturbance,  that  Ave  are  justified 
in  considering  local  distress  as  a  mere  symptom  of  general  disease. 

Complicated  Diseases. — Unfortunately,  neither  a  general  nor  a  local 
disease  gives  the  sufferer  any  positive  security  against  the  onset  of  another 
malady  at  the  same  time,  and  we  often  see  people  burdened  with  a  compli- 
cation of  disorders,  each  of  which  by  its  symptoms  obscures  the  rest,  and 
perhaps  renders  the  proper  treatment  for  them  inadmissible.  It  is  this 
tendency  to  the  development  of  complications,  either  secondary  to  the 
chief  disease  or  entirely  independent  of  it,  which  in  many  affections  is  the 
indirect  cause  of  death. 

Damaged  Organs — ^Frequently,  too,  after  a  severe  illness,  some  impor- 
tant organ  is  damaged  in  its  structure,  and  the  patient  for  the  rest  of  his 
life  suffers  for  want  of  its  proper  performance  of  function  throughout  his 
whole  organism,  which  is  really  as  much  crippled  in  its  work  as  a  man 
would  be  if  his  leg  or  arm  had  been  left  upon  a  battlefield.  This  is 
especially  the  case  with  the  heart  after  an  attack  of  inflanmiatory  rheu- 
matism, which,  by  affecting  the  cardiac  valves,  prevents  the  circulation  of 
the  blood  from  being  duly  carried  on,  and,  as  it  grows  worse  in  later  years, 
is  apt  to  terminate  existence  abruptly  by  sudden  death,  or  by  the  painful 
method  of  prolonged  and  lingering  illness. 

Care  in  Dosing. — The  greatest  care  must  be  exercised  in  portioning 
out  the  doses  of  medicines  suggested  for  the  treatment  of  the  diseases 
described,  and  it  should  always  be  recollected  that  a  mistake  which  is  a 
mere  blunder  in  other  vocations  may  at  any  moment  become  a  crime  in 
the  occupations  of  prescribing,  preparing,  or  administering  medicines. 
Hence  the  doctor,  the  apothecary  and  the  nurse,  who  have  always  the 
life  of  the  patient  in  their  keeping,  should  be  persons  who  are  willing  and 
able  to  fully  realize  their  responsibility;  those  who,  whilst  on  duty,  are 
unceasingly  and  vigilantly  on  guard  against  committing  an  error  of  any 
kind. 


264  THE  EEUPTIVE  DISEASES. 

Doses  Are  Always  for  Adults. — The  doses  of  medicines  recommended 
in  this  section  of  the  work  are  always  for  adults,  unless  otherwise  ex- 
pressly stated,  and  must  be  proportionately  reduced  for  children  according 
to  age.  Thus,  for  a  young  person  of  from  fourteen  to  sixteen  years,  two- 
thirds  of  the  ordinary  dose  should  be  given;  from  ten  to  thirteen,  about 
one-half;  from  eight  to  ten,  two-fifths;  from  six  to  eight,  one-third;  for 
a  child  of  four  or  five  years,  one-fourtli ;  for  one  of  three  years,  one-fifth ; 
for  one  of  two  years,  one-seventh;  for  an  infant  of  one  year,  one-thir- 
teenth; and  for  a  baby  of  from  three  to  six  months,  one-twenty-fourth. 

Doses  for  Children. — For  example,  the  average  dose  of  bromide  of 
potassium  for  a  gro^m  person  being  twenty  grains,  that  for  a  youth 
between  fourteen  and  sixteen  years  would  be  sixteen  grains ;  between  ten 
and  thirteen,  ten  grains;  between  eight  and  ten,  eight  grains;  between 
six  and  eight,  seven  grains;  between  four  and  five,  five  grains;  at  three 
years,  four  grains ;  at  two  years,  three  grains ;  at  one  year,  a  grain  and  a 
half;  and  at  six  months,  three-quarters  of  a  grain. 

How  to  Graduate  Doses — These  fractional  amounts  are  most  conven- 
iently arranged  for  young  children  by  diluting  a  single  dose  for  an  adult 
with  the  requisite  number  of  teaspoonfuls  of  pure  water.  That  is  to  say, 
using  the  above  illustration,  if  it  is  desired  to  administer  bromide  of  potas- 
sium to  a  child  one  year  old  threatened  with  convulsions,  twenty  grains  of 
the  drug  might  be  dissolved  in  thirteen  teaspoonfuls  of  water,  and  a  tea- 
spoonful  given  every  liour  or  two. 

Whj  Doses  Should  Vary — The  doses  of  medicine  vary,  as  already 
pointed  out  in  the  earlier  part  of  this  volume,  in  accordance  with  sex, 
idiosyncrasy  and  habit,  and  one  of  the  most  important  advantages  enjoyed 
by  a  skilled  family  physician  is  his  power,  gained  by  long  practical  experi- 
ence, of  so  adapting  each  dose  of  medicine  to  every  individual  of  a  family, 
as  to  gain  the  greatest  amount  of  benefit  with  the  least  amount  of  injury 
in  any  particular  case. 

Opiates  and  Emetics — The  general  rule  given  above  in  regard  to  doses 
of  medicines  to  children  has  some  exceptions,  the  most  important  being 
in  regard  to  opium,  which  is  not  well  borne  in  childhood,  and  calomel  or 
castor-oil,  of  which  a  larger  proportionate  quantity  may  bo  administered. 
In  regard  to  the  frequency  of  repetition  of  medicines,  it  should  be  under- 
stood that  when  not  otherwise  stated,  this  may  be  judged  of  by  the  effect 
produced.  Thus,  as  a  rule,  an  emetic  may  be  repeated  in  fifteen  minutes 
if  the  patient  does  not  vomit ;  an  opiate  may  be  repeated  in  an  hour  if  pain 


SMALL-POX.  265 

still  continues  witboTit  mitigation,  and  a  cathartic  in  from  six  to  eight 
hours  if  no  purgative  action  is  effected. 

Change  of  Medicines — In  those  unfortunate  patients  who  cannot  take 
laudanum,  morphia,  or  paregoric  for  the  relief  of  pain,  which  constitutes 
the  great  symptom  of  disease,  codeia,  chloral,  hyoscyamus,  bromide  of 
potassium,  Indian  hemp,  and  lactucarium  may  he  used  as  substitutes,  but 
without  much  expectation  that  they  will  fully  serve  the  purpose  of  opiimi, 
that  greatest  boon  to  suffering  himianlty. 

THE  ERUPTIVE  AND  ACUTE  INFECTIONS 

SMALL-POX  OR  VARIOLA. 

Definition. — An  acute  and  highly  contagious  disease  characterized  (a) 
by  an  eruption,  which  by  the  third  day  is  papular,  by  the  sixth  day  is 
vesicular  and  by  the  ninth  it  becomes  pustular  (h)  by  a  fever  which  ap- 
pears with  the  onset,  disappears  with  the  eruption,  but  returns'  again  when 
the  eruption  becomes  pustular. 

History — Small-pox  was  first  accurately  described  by  Khazes,  an 
Arabian  physician,  in  the  ninth  century,  and  distinguished  by  him  from 
measles,  but  it  is  believed  to  be  the  same  as  the  pesta  magna  described  by 
Galen  (A.  D.  130-200).  It  is  known  to  have  prevailed  during  the  sixth 
century  and  again  about  the  time  of  the  Crusades.  The  disease  is  believed 
to  have  been  introduced  into  America  by  the  Spaniards  early  in  the  six- 
teenth century. 

Cause — Small-pox  is  one  of  the  most  virulent  of  the  contagious  dis- 
eases, the  poison  of  which  is  extremely  tenacious  of  life ;  it  may  remain 
latent  in  clothes  for  a  long  time,  and  then  be  capable  of  exciting  the 
disease.  The  contagion  exists  in  the  secretions  and  excretions,  and  in  the 
exhalations  from  the  lungs  and  skin.  The  dried  scales  constitute  by  far 
the  most  important  element,  becoming  attached  to  clothing  and  furniture ; 
and  are  conveyed  by  persons  who  have  been  in  contact  with  the  sick.  The 
disease  is  probably  contagious  from  a  very  early  stage,  though  it  has  not 
yet  been  determined  whether  the  contagion  is  active  before  the  eruption 
develops.  The  degree  of  mildness  or  severity  of  a  case  does  not  influence 
that  of  another  caused  by  it,  the  severest  cases  being  at  times  followed  by 
the  mildest  forms,  and  vice  versa. 

Age — Unless  protected  by  vaccination  or  a  previous  attack,  nearly 
every  one  is  susceptible,  from  the  aged  to  the  child  in  the  womb.  '  The 
disease  is  usually  fatal  in  the  very  young. 


266  THE   ERUPTIVE   DISEASBS. 

Sex. — Male  and  female  are  equally  affected. 

Race The  North  American  Indian  and  the  negro  are  particularly 

susceptible  to  it. 

Nature  of  the  Disease. — The  eruption  consists  in  an  infiltration  of  cells 
into  the  rete  mucosum  or  into  the  true  skin.  Genuine  pock  marks  are  fre- 
quently found  in  the  mouth,  oesophagus  and  larynx  and  there  are  paren- 
chymatous or  soft  cellular  tissue  degenerations  iu  other  organs. 

Varieties — Discrete,  confluent,  malig-nant  and  varioloid. 

Symptoms — 1st.  Discrete  form:  After  a  period  of  incubation  of 
from  nine  to  fifteen  days  (Osier),  seven  to  twelve  days  (Tyson),  the 
disease  is  ushered  in  -with  a  chill  in  adults,  and  with  a  conxiilsion  in  chil- 
dren. There  is  an  intense  frontal  headache  and  agonizing  lumbar  pains, 
and  vomiting.  The  pains  in  the  limbs  and  back  are  more  severe  in  the 
initial  stage  of  this  than  of  any  other  eruptive  fever,  and  connected  with 
the  frontal  headache  and  vomiting  are  specially  and  decisively  charac- 
teristic, or  pathognomonic,  of  this  disease. 

Fever  sets  in  rapidly  and  may  go  as  high  as  103  or  104  the  first 
day ;  the  pulse  is  rapid,  hard  and  strong  at  this  stage.  Delirium  may  be 
present,  and  is  at  times  violent.  The  face  is  flushed  and  the  eyes  are 
bright  and  clear. 

The  Eruption.— About  the  third  or  fourth  day  small  red  spots  are 
noticed,  first  on  the  forehead  and  wrists,  from  which  it  rapidly  spreads 
over  the  face  and  extremities.  At  this  stage  the  eruption  is  not  unlike 
measles,  but  in  another  twenty-four  hours  it  is  quite  different,  the  j^apules 
having  a  ''shot-like  feeling,"  from  which  stage  they  pass  into  the  other 
two  stages  mentioned  in  the  definition.  As  the  eruption  comes  out  the 
fever  falls,  symjitoms  abate  and  the  patient  feels  more  comfortable.  On 
the  fifth  OT  sixth  days  the  papules  become  converted  in  the  vesicles,  which 
contains  a  clear  fluid,  the  vesicle  itself  having  a  depressed  or  umbilicated 
centre.  By  the  eighth  or  ninth  day  the  vesicles  are  converted  into  pustules, 
the  umbilication  disappears  and  the  fluid  becomes  a  grayish-yellow,  owing 
to  the  contained  pus.  At  this  stage  the  fever  rises  and  the  general 
symptoms  return.  In  the  discrete  form  the  fever  does  not  usually  remain 
high  for  more  than  twenty-four  or  twenty-six  hours,  so  that  on  the  tenth 
or  eleventh  day  the  fever  disappears  and  convalescence  sets  ih.  By  the 
fourteenth  day  the  pustules  become  dry,  are  converted  into  crusts  and 
drop  off,  leaving,  in  mild  cases,  a  simple  discoloration  which  in  time  dis- 
appears, but  in  severe  cases  a  more  or  less  deep  ulcer,  or,  if  cicatrization 
be  complete,  a  simple  pit. 


SMALL-POX. 

Discrete  or  Separate  Form. 


©  K.  T.  S. 


SMALL-POX. 

Confluent  or   Enniasicd   Ff)rm. 


BMAXL-POX.  267 

Symptoms  of  the  Confluent  Form. — 2(1.  This  form  has  the  same  initial 
symptoms  as  the  discrete,  but  they  are  of  greater  severity.  The  eniption 
iu  this  variety  comes  out  earlier  than  iu  the  ahove-mentioned  form. 
Sydenham  early  called  attention  to  the  fact  that  the  earlier  the  eruption 
appeared  the  more  danger  there  was  in  its  assuming  the  confluent  variety. 
In  this  variety  the  fever  does  not  abate  on  the  appearance  of  the  eruption 
as  it  does  in  the  discrete  form.  The  face,  hands  and  feet  present  an  almost 
continuous  pustule,  which  often  bursts  in  places,  and,  the  pus  partly  dry- 
ing, there  results  a  picture  which  is  horrible  in  the  extreme.  Tnie  pocks 
nearly  always  develop  in  the  air  passages,  and  give  rise  to  a  copious  fetid 
discharge  from  the  nose  and  throat.  Should  the  patient  recover  it  is  only 
after  a  tedious  convalescence,  with  great  facial  disfigurement  and  often 
with  defective  vision  and  hearing. 

Malignant  Form — 3d.  In  some  cases  this  form  of  the  disease  is 
ushered  in  with  a  high  fever,  excruciating  pains  in  the  back  and  vomiting. 
The  hemorrhagic  rash  appears  early,  while  the  hemorrhage  takes  place 
from  the  mucous  membrane  or  surfaces,  generally  on  the  evening  of  the 
second  or  third  day,  and  the  patient  may  die  in  from  two  to  six  days,  some- 
times even  before  the  eruption  makes  its  appearance.  The  face  is  swollen 
and  large  conjunctival  hemorrhages,  with  the  deeply  sunken  cornea;,  give 
a  ghastly  appearance  to  the  features.  The  mind  generally  remains  clear, 
but  death  is  the  usual  result. 

Varioloid — 4th.  This  is  small-pox  which  is  modified  by  a  previous 
attack  or  by  vaccination.  The  attack  may  come  on  with  the  symptoms  as 
severe  as  In  the  discrete  form,  liut  usually  the  initial  fever  is  less,  the  erup- 
tion is  less  general  and  may  abort  in  Its  early  development,  the  secondary 
fever  is  less  marked  and  convalescence  sets  in  earlier.  Vesication,  or 
blistering,  takes  place  rapidly,  as  there  is  rarely  any  scarring. 

Diagnosis — The  diagnosis  or  recognition  of  small-pox  is  of  great  im- 
portance, and  many  an  anxious  hour  is  often  passed  by  the  physician, 
the  patient,  and  the  friends  of  the  latter  before  It  is  jiossible  to  decide  with 
certainty  as  to  the  nature  of  the  disease.  ^^Tiiile  small-pox  may  be  mis- 
taken for  a  number  of  affections,  the  chief  difficulty  after  the  eniption 
begins  to  come  out  is  in  distingiilshing  it  from  measles  and  from  chicken- 
pox.  Of  course,  it  is  very  Important  to  make  the  diagnosis  at  the  earliest 
possible  moment,  in  order  that  timely  precautions  against  the  spreading 
of  the  disorder  shall  be  Instituted.  After  the  pimples  begin  to  contain 
fluid,  the  danger  of  mistaking  the  malady  for  measles  is  over,  because  the 


26S  THE  ERUPTIVE  DISEASES. 

general  eruption  of  measles  is  never  vesicular,  although  a  few  little 
blisters  are  occasionally  seen  in  bad  cases. 

To  Distinguish  from  Measles. — In  many  instances  a  probable  opinion 
can  be  given  that  a  disease  is  measles  and  not  small-pox,  from  the  fact  that 
the  eruption  of  pimples  is  softer,  less  shot-like,  and  arranged  in  obscurely 
defined  crescents  upon  the  arms  and  neck.  In  others,  however,  it  is  impos- 
sible to  decide  before  the  second  day  of  the  eruption,  when,  as  a  rule,  some 
few  of  the  pimples  will  be  found  slightly  vesicular  if  the  disease  is 
small-pox. 

To  Distinguish  from  Chicken-Pox "When  the  vesicles  appear,  the  great 

point  of  distinction  between  them  and  the  vesicles  of  chicken-pox  is  thr.t 
the  small-pox  vesicle  is  depressed  in  the  middle,  giving  it  what  is  called  the 
umbilicated  or  navel-like  aspect.  This  is  an  important  characteristic,  and 
should  always  be  carefully  looked  for.  Before  the  eruption  comes  out, 
only  a  probable  guess  can  be  made  in  many  instances. 

Unusual  Symptoms. — Dr.  Flint,  perhaps  the  most  acute  diagnostician 
in  America,  says  that  decided  fever  following  immediately  after  a  chill, 
the  fever  continuing  without  much  remission  for  two  days,  pain  in  the 
back  being  a  prominent  symptom,  if  it  be  known  that  the  patient  has  been 
exposed  to  small-pox,  or  if  this  disease  is  prevalent,  renders  the  diagnosis 
extremely  probable.  In  comparatively  rare  cases,  unusual  symptoms  in  an 
attack  of  small-pox  might  for  a  day  or  two  render  the  diagnosis  difficult 
from  scarlet  fever,  the  simple  mild  fever  called  febricula,  the  skin  disease 
called  lichen,  some  of  the  pustular  eruptions  of  the  venereal  disease,  and 
in  its  very  earliest  stage  from  erysipelas  and  typhoid  fever. 

Treatment. — Since  we  have  as  yet  discovered  no  antidote  for  the 
small-pox  poison,  the  chief  treatment  is  the  relief  of  symptoms,  as  far  as 
possible,  as  they  arise,  and  careful  nursing,  in  order  to  avoid  needless 
aggravation  of  the  disease  or  the  development  of  complications.  The  mild- 
est cases,  as  well  as  those  which  are  more  severe,  should  be  kept  in  bed  in 
a  cool  apartment,  which  is  ventilated  £S  freely  as  possible,  without  pro- 
ducing dangerous  draughts. 

The  Back — In  bad  cases  the  patient's  back  ought  to  be  frequently 
examined,  and  suitable  precautions  taken  against  the  formation  of  bed- 
sores, as  recommended  under  the  head  of  typhoid  fever,  the  hair  cut 
off  close,  in  order  to  avoid  the  matting  with  the  corruption  from  the 
pustules  when  that  begins  to  discharge. 

The  Bowels — The  bowels  should  be  well  opened  as  soon  as  fever 
develops  with  a  tablespopnfy]  of  c8stor-oil,  or  a  saline  purgative,  such  as 


Two  children  in  the  Municipal  Hospital,  one  unvaccinated  and  the  other  vac- 
cinated on  the  day  of  admission — the  crust  is  still  seen  upon  the  leg.  This  child 
remained  in  the  hospital  with  its  mother  (who  was  suffering  from  small-pox)  for 
three  weeks,  and  was  discharged  perfectly  well.  The  unvaccinated  child  admitted 
.with  small-pox  died.     (Welch  and  Scharaberg.) 

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SMALL-POX.  269  - 

a  Seidlitz  powder  or  a  bottle  of  citrate  of  magnesia,  and  then  a  cooling 
and  diaphoretic  mixtnre,  composed  of  half  a  teaspoonfiil  of  sweet  si)irit3 
of  nitre,  ten  grains  of  bromide  of  potassium,  or  phenacetnm,  four  grains, 
every  three  or  four  hours,  for  fever,  and  an  ice  cap  to  the  head  for  the 
violent  headache,  administered  every  two  or  three  hours  if  there  is  much 
pain  or  restlessness.  After  the  primary  fever  subsides,  with  the  coming  out 
of  the  eruption,  there  are  often  a  few  days  during  which  no  medical  treat- 
ment is  necessary;  but  with  the  appearance  of  the  secondary  fever,  the 
cooling  mixture  should  be  resumed.  Quinine,  tincture  of  iron  and  brandy 
should  be  given  in  full  doses. 

The  Itching — To  relieve  the  itching,  which  is  sometimes  almost  intol- 
erable, the  surface  of  the  skin  may  be  sponged  over  with  a  weak  solution 
of  sulphurous  acid  or  of  carbolic  acid,  six  or  eight  drops  to  the  ounce  of 
water.  If  no  relief  is  obtained  from  these,  anointing  the  body  with  cosmo- 
line  or  with  cold  cream  may  be  tried ;  but  it  is  sometimes  needful  to 
mufEe  the  hands,  especially  of  children,  in  order  to  prevent  them  from 
scratching  ojjen  the  pocks  after  they  begin  to  heal,  and  so  rendering  the 
resulting  scars  much  deeper  and  more  permanent.  Keep  the  patient  in  a 
dark  room  and  cover  the  face  with  a  mask  of  mercurial  ointment,  and  to 
prevent  pitting  the  pustles  may  bo  touched  with  tincture  of  iodine. 

The  Fever — The  fever,  when  higli,  must  be  kept  within  limits,  either 
by  cold  sponging  or  by  the  cold  bath,  the  water  being  at  a  temperature  of 
75  degrees  when  the  patient  is  first  put  in  and  then  gradually  lower  it  to 
68  degrees.  During  convalescence  bathing  should  be  frequent,  as  it  helps 
to  soften  the  crusts.  In  malignant  small-pox,  which  generally  proves 
fatal,  where  very  soon  the  face  becomes  so  swollen  that  the  eyelids  are 
tightly  closed  and  glued  together,  they  should  be  frequently  bathed  with 
a  saturated  solution  of  boric  acid.  The  mouth  and  nose  should  be  kept 
clean  and  soft  by  frequent  injections.  The  patient  should  have  plenty  of 
cold  water.  Should  the  heart  become  weak  hypodermics  of  strychnine, 
one-thirtieth  of  a  grain,  or  dram  doses  of  aromatic  spirits  of  ammonia  by 
the  mouth. 

Treatment  of  Malignant  Small-Pox. — In  malig-nant  small-pox,  and  in 
the  petechial  or  hemmorrhagic  form,  the  black  small-pox  of  common  lan- 
guage, the  only  chance  of  successful  treatment  is  to  support  the  strength 
with  qiiinine  in  four-grain  doses  thrice  daily,  or  Peruvian  bark  and  other 
tonics,  and  with  stimulants  such  as  wine  or  brandy  or  milk-punch,  in  the 
forlorn  hope  that  unusual  vigor  of  the  constitution  may  thus  be  reinforced 
long  enough  for  the  violence  of  the  disease  to  become  expended.     If  the 


270  THE  ERUPTIVE  DISEASES. 

patient  can  tlms  be  kept  alive  until  after  the  twelfth  or  fifteenth  day  with- 
out any  important  organ  becoming  seriously  damaged  in  its  structure,  the 
chance  of  recovery  will  subsequently  increase  every  day.  The  disease 
being  self-limited,  it  is  obviously  our  chief  duty,  in  the  absence  of  any 
known  specific,  to  direct  our  energies  toward  sustaining  the  patient's 
strength  in  his  battle  with  the  disorder,  and  the  prospect  of  recovery,  or 
prognosis,  as  it  is  termed,  turns  upon  the  relative  power  of  endurance  of 
the  disease-poison  and   the   patient's  constitution. 

Diet — The  diet  in  the  early  stage  of  small-pox,  like  that  in  most 
febrile  conditions,  should  be  light  and  unstimulating,  consisting  of  rice, 
cornstarch,  bread  and  milk,  or  arrow-root.  Oranges  or  lemonade  in  modera- 
tion may  be  allowed,  unless  there  is  a  tendency  to  diarrhoea.  Ice  water, 
lumps  of  ice,  or  iced  carbonic  acid  water  may  be  given  ad  libitum.  Later 
on  in  the  disorder,  when  the  strength  begins  to  fail  and  the  pulse  grows 
weaker,  strong  animal  broths,  beef  essence,  and  other  highly  nutritious 
aliments  are  necessary;  and  if  the  pulse  at  the  wrist  should  seem  very 
feeble,  and  especially  if  it  should  become  intermittent,  milk-punch,  egg- 
nogg,  or  other  powerful  stimulants  ought  to  be  resorted  to. 

Nursing-  in  Small-Pox. — The  general  care  of  a  small-pox  patient  ought 
to  be  afforded  in  accordance  with  directions  contained  in  the  chapter  on 
Xursiug,  and  most  of  the  special  precautions  for  avoiding  the  extension 
of  the  disease,  and  so  forth,  have  been  pointed  out  in  the  article  on  Con- 
tagious Influence.  On  account  of  the  danger  of  pneumonia  and  pleurisy, 
particular  watchfulness  is  needed  against  taking  cold  from  draughts  of 
air,  and  during  the  delirium  of  the  fourth  stage,  in  bad  cases,  the  atten- 
dant must  be  constantly  on  guard  to  jirevent  the  patient  from  injuring 
himself  or  others.  The  nurse  should  wear  an  overall  and  remove  it  on 
coming  out  of  the  room,  and  her  head  should  be  covered  with  a  cap. 

VACCINATION  THE  GEEAT  PREVENTIVE  OF  SMAXL-POX. 

Seeing,  then,  that  small-jjox  is  a  most  painful,  loathsome,  and  fatal 
disease,  for  which  we  have  no  cure,  it  becomes  infinitely  important  to  avail 
ourselves  of  the  protection  against  its  ravages  afforded  by  Dr.  Tenner's 
beneficent  discovery  of  vaccination,  a  discovery  which  ought  to  make  his 
name  honorable  whilst  the  world  stands. 

And  yet,  strange  to  say,  there  are  people  bearing  the  general  aspect 
of  reasoning  beings  who  oppose  vaccination ;  and  in  England,  where  vac- 
cination has  been  made  compulsory  by  law,  a  league  has  been  formed  to 


2  . 

ot: 
> 


oow-pox,  271 

combat  its  enforcement,  liecently  the  folly  of  these  fanatics  met,  it  is 
stated,  with  a  most  righteous  punishment  in  the  following  circumstance: 
A  leading  anti-vaccinationist,  Escott  by  name,  who  refused  to  have  any 
of  his  children  vaccinated,  lately  lost  two  of  them  and  his  wife  by  small- 
pox. Escott  borrowed  a  suit  of  clothes  from  a  friend  to  attend  his  wife's 
funeral,  and  returned  them  without  disinfection,  with  the  result  that  the 
lender  caught  small-pox  and  also  died  of  it.  Subsequently  nearly  every 
house  in  the  neighborhood  was  infected,  producing  a  local  epidemic  of 
small-pox,  during  which  sixteen  patients  were  removed  to  the  pest-house. 
The  only  excuse  for  the  obstinacy  of  such  deluded  people  is,  that  more 
than  half  a  century  of  deliverance  from  the  horrors  of  small-pox  has  ren- 
dered most  persons  practically  ignorant  of  its  dangers.  In  the  latter  half 
of  the  eighteenth  century,  that  is,  from  1750  to  1800,  small-pox  attacked 
almost  every  inhabitant  of  England,  and  about  one  out  of  every  five  seized 
with  it  died,  whilst  nearly  another  fifth  of  its  victims  were  disfigured  or 
crippled  for  life.  It  is  estimated  that  two-thirds  of  the  blind  people  in 
England  at  that  time  lost  their  sight  from  small-pox.  To  give  an  idea  of 
its  relative  mortality,  Dr.  Guy  states  that  it  caused  eighteen  per  cent,  of 
all  the  deaths,  and  was  one  hundred  times  as  fatal  as  diarrhoea,  with  its 
allied  intestinal  disorders,  and  six  times  as  fatal  as  apoplexy,  palsy  and 
sudden  death  taken  together. 

Objections  to  Vaccination — These,  aside  from  the  mere  sentimental 
ones  are  that  in  some  instances  erysipelas  and  venereal  disease  have  been 
apparently  caused  by  it,  and  that  it  has  been  accused  of  being  the  means 
of  inoculating  the  human  system  with  scrofula,  consumption  and  certain 
cutaneous  affections.  Now,  all  of  these  objections  can  be  removed  by  the 
use  of  what  is  called  bovine  virus,  obtained  direct  from  the  cow,  with- 
out ever  having  passed  through  any  human  body.  Glycerinized  lymph  is 
now  conceded  to  be  tlie  better  vaccine  virus. 

Duty  of  Vaccination This  Is  rendered  far  more  imperative  by  the 

danger  which  every  unprotected  person  in  a  commimlty  exposes  his  neigh- 
bors to  by  becoming  the  starting-point  of  an  epidemic  of  small-pox.  Hence, 
although  a  man  may  have  the  privilege  of  thus  trifling  with  his  own  life 
and  health,  he  has  no  right  to  Imperil  others  by  his  perversity  or  ignor- 
ance ;  and  the  good  of  society,  which  is  a  higher  law  than  that  of  personal 
liberty,  demands  that  compulsory  vaccination  be  legally  established,  as 
it  Is  hoped  It  will  bo  ere  many  years  elapse. 

Making  Sure  of  Immunity — ^Evon  after  exposure  the  individual 
should  be  vaccinated,  for  though  it  may  not  prevent  small-pox,  it  will  ce]> 


272  THE  EETTPTIVE  DISEASES. 

tuinly  moderate  the  severity  of  tlic  attack.     The  writer  Las  bad  a  case  ol 
this  kind  to  come  under  his  personal  observation. 

COW-POX  OR  THE  VACCINE-DISEASE. 

How  Produced. — This  disease,  called  Vaccina  in  medical  books,  is 
indileed  in  the  human  being  by  the  process  of  vaccination,  either  acci- 
dentally, as  in  the  case  of  the  young  milkmaid  who  led  Dr.  Jenner  to  his 
grand  discovery,  or,  as  is  usual  nowadays,  by  being  rubbed  into  a  slight 
wound  made  for  the  purpose.  It  is  apparently  a  modified  form  of  small- 
])ox,  in  which  a  cow-pox  vesicle  on  the  iiddcr  of  a  cow  or  heifer  is  the  com- 
mon original  source  of  the  infecting  matter. 

Character — The  disease  is  attended,  as  a  rule,  with  no  further  erup- 
tion than  the  vesicle,  ripening  into  a  pustule  at  the  point  or  points  where 
the  matter  is  inoculated.  It  is  communicable  by  inoculation,  biit  not  by 
the  other  ordinary  modes  of  infection,  mild  in  its  course,  and  yet,  gen- 
erally speaking,  protective  against  small-pox. 

Operation  of  Vaccination. — This  is  by  no  means  so  simple  and  imim- 
portant  as  it  seems  at  first  sight,  and  it  therefore  ought  always  to  be  per- 
formed by  a  physician.  It  is  better  not  to  cut  so  deep  in  vaccinating  as 
to  cause  much  of  a  flow  of  blood,  lest  this  fluid  should  wash  the  virus  out 
of  the  incisions.  The  usual  place  for  vaccinating  is  on  the  outside  of  the 
arm,  an  inch  or  two  below  the  shoulder ;  but  if  the  operation  fails  here,  as 
is  sometimes  the  case  after  repeated  trials,  an  attempt  may  be  made  on 
the  calf  of  the  leg,  just  below  the  knee. 

When  to  Vaccinate — ^Vaccination  should  be  performed  on  all  chil- 
dren between  the  ages  of  one  and  three  months,  unless  some  special  rea- 
son exists  for  its  postponement,  and  it  is  recommended  to  insert  the  virus 
in  foTir  or  five  places  close  together,  so  as  to  produce  several  pustules, 
although,  by  a  majority  of  physicians  in  this  country,  one  pock  is  thought 
sufficient. 

Revaccination — Revaccination  should  be  performed  about  once  in 
seven  years,  as  in  some  instances  the  protection  afforded  appears  to  wear 
out  in  that  time ;  and,  as  there  is  no  means  of  recognizing  them,  the  safer 
way  is  to  renew  the  vaccination. 

The  Vims — The  animal  or  bovine  virus  is  supplied  from  carefully 
vaccinated  calves  by  a  number  of  producers  in  various  parts  of  the  country. 
It  is  usually  furnished  on  little  ivory  points,  shaped  like  a  lancet-blade, 
or  on  pieces  of  quills.     Either  of  these  is  to  be  moistened  iu  pure  water, 


BKEAK-BONE   FEVEK.  273 

and  then  rubbed  on  a  lightlj  scarified  surface,  prepared  as  already 
described.  The  bovine  virus  is  apt  to  make  a  very  sore  arm,  b\it  has  the 
great  advantage  of  avoiding  all  possibility  of  introducing  the  horrible 
poison  of  venereal  disease  into  the  blood  of  the  infant  operated  upon. 

VAEICELLA  OR  CHICKEN-POX. 

For  full  description  and  treatment  of  this  disease,  peculiar  to  chil- 
dren, see  Childeen's  Diseases. 

MEASLES  OR  RUBEOLA  OR  MORBILLI, 

For  full  description  and  treatment  of  measles,  see  Diseases  of 
Children. 

RUBELLA,  ROTHELN  OR  GERMAN  MEASLES. 

Definition — An  acute  infectious  disease  resembling  both  scarlet  fever 
and  measles,  but  differing  from  these  in  its  short  course,  slight  fever  and 
freedom  from  complications. 

Cause. — It  is  propagated  by  contagion  and  spreads  with  great  rapidity. 

Incubation — About  two  weeks. 

Symptoms. — This  is  a  mild  contagious  affection,  very  similar  in  many 
respects  to  ordinary  measles,  but  apparently  differing  from  it,  because 
neither  disease  affords  any  protection  from  the  other.  The  color  of  the 
eruption  is  rather  more  rose-tint  than  in  ordinary  measles,  the  pimples 
are  round  instead  of  oval,  and  the  crescentic  arrangement  is  wanting  or 
extremely  obscure.  Children  are  chiefly  affected  with  German  measles, 
although  it  also  occurs  after  adult  age  is  attained,  but  in  any  case  the 
malady  is  so  slight  that  the  patients  rarely  feel  sick  enough  to  keep  in  bed, 
and  no  instances  of  death  from  the  uncomplicated  affection  are  recorded. 

Treatment. — The  treatment,  diet  and  nursing  appropriate  to  German 
measles  are  the  same  as  those  recommended  in  the  ordinary  form,  in  the 
few  cases  where  any  special  care  is  needed. 

SCARLET  FEVER  OR  SCARLATINA. 

For   description   and   treatment   of   scarlet   fever,    see   Diseases   of 
Chii-deen. 
18 


274  THE  EEtrPTIVE  DISEASES. 


BKEAK-BONE  FEVER  OR  DENGUE. 

Synonyms.— Dandy,  or  break-bone  fever. 

Definition. — An  acute  and  infectious  disease  characterized  by  febrile 
paroxysms;  pain  in  the  muscles  and  joints  and  sometimes  by  an  eruption 
on  the  skin. 

History  and  Geographical  Distribution The  disease  was  first  recog- 
nized in  1779  in  Cairo  and  in  Java.  The  description  by  Benjamin  Rush 
of  the  epidemic  in  Philadelphia  in  1780  is  one  of  the  first  and  one  of  the 
very  best  articles  ever  written  on  the  disease.  S.  H.  Dickson  gives  a 
graphic  description  of  the  disease  as  it  appeared  in  Charleston  in  182S. 
Since  that  date  there  have  been  five  or  six  widespread  epidemics  in 
tropical  countries,  the  last  occurring  along  the  Gulf  States  in  the  summer 
of  1897,  where  for  some  time  it  was  supposed  to  be  yellow  fever,  j^one 
of  the  recent  epidemics  have  extended  to  the  Northern  States,  but  in  1888 
it  prevailed  as  far  north  as  Virginia. 

Cause — The  rapidity  of  diffusion  and  the  pandemic  character  are  the 
two  luost  important  features  of  dengue.  There  is  no  disease,  not  even 
influenza,  which  attacks  so  large  a  proportion  of  the  population.  A  micro- 
coccus has  been  found  in  the  blood  of  patients  by  McLaughlin,  of  Texas. 

Symptoms — Incubation. — Three  to  five  days,  during  which  the  patient 
feels  well.  Persons  who  catch  this  curious  complaint  are  often  attacked 
with  it  very  suddenly,  frequently  in  the  night  after  retiring  in  their 
usual  health.  The  temperature  rises  in  a  few  hours  to  103  degrees  and 
in  one  or  two  days  may  reach  106  or  107  degrees,  the  skin  becomes  dry 
and  hot,  and  the  countenance  indicates  utter  helplessness  and  prostration ; 
with  this  febrile  condition  there  is  usually  pain  in  the  head,  back,  limbs 
and  small  joints,  which  latter  swell  up  as  in  rheumatism.  The  pulse  is 
rapid;  loss  of  appetite,  coated  tongue,  slight  nocturnal  delirium  and  con- 
centrated urine.    The  pain  may  be  so  severe  that  the  patient  cannot  move. 

Duration — The  average  duration  of  the  first  febrile  stage  is  about 
forty-eight  hours,  although  it  may  vai-y  from  twelve  hours  to  three  days, 
after  which  the  symptoms  begin  to  subside  and  a  period  of  remission  of 
two  or  three  days  occurs. 

Debility  and  Eruption. — During  this  time  general  debility  and  mus- 
cular pains  predominate,  and  fever  is  usually  absent,  but  on  the  fourth 
day  it  reappears,  and  on  the  fifth  or  sixth  an  exanthematous  eruption 
develops,  which  is  sometimes  more  like  the  flush  of  erysipelas  than  the 


TYPHUS  FEVEE.  275 

papules  of  either  measles  or  scarlet  fever.  The  color,  however,  is  not  so 
intense,  and  it  spreads  over  the  whole  body  in  forty-eight  hours. 

Pains  and  Swelling. — When  the  eruption  reaches  its  height,  painful 
swellings  of  the  lymphatic  glands  of  the  neck,  back  of  the  head,  armpits 
and  groins  occur.  With  this  tumefaction  of  the  glands,  the  nose,  mouth 
and  throat  become  implicated,  swelling  up  and  growing  excessively  pain- 
ful. On  the  seventh  or  eighth  day  desquamation  commences  and  the  acute 
stage  terminates. 

Malady  Not  Fatal. — The  victims  of  dengue  are  to  be  commiserated 
for  the  horrible  and  agonizing  pains  which  they  are  called  upon  to  suffer, 
and  which  are  peculiar  to  the  disease;  but  they  may  find  some  comfort 
in  the  assurance  that  the  malady  is  rarely,  if  ever,  fatal. 

Recurrence  of  Pain. — The  recurrence  of  the  excruciating  pains  in  the 
limbs  at  a  time  long  after  the  subsidence  of  the  fever  must  be  borne  in 
mind,  as  influencing  any  opinion  ventured  in  regard  to  the  probable 
duration  of  the  illness. 

Diagnosis The  diagnosis  of  dengue  must  occasionally  be  made  from 

rheimiatism,  measles,  scarlet  fever  and  erysipelas ;  but  a  complete  history 
of  the  case  can  hardly  fail  to  clear  up  any  doubts,  particularly  if  dandy 
fever  is  prevailing  in  the  locality  as  an  epidemic. 

Remedies — Since  the  malady  is  not  a  dangerous  one,  anodynes  to 
relieve  the  excruciating  suffering,  especially  hypodermic  injections  of 
one-eighth  or  one-sixth  of  a  gTain  of  morphia.  During  convalescence 
iodide  of  potash  is  recommended  for  the  arthritic  pains  and  tonics  are 
indicated. 

TYPHUS  FEVER. 

Synonyms. — Ship,  jail  or  putrid  fever. 

Definition. — An  acute  infectious  disease  favored  by  closely  crowding 
human  beings  together,  characterized  by  sudden  onset,  a  maculated  rash, 
marked  nervous  symptoms  and  a  termination  by  crisis  about  the' end  o£ 
the  second  week. 

Causes. — It  is  excited  by  an  xmknown  poison  which  is  capable  of 
being  carried  in  the  clothes.  It  is  rare  in  America,  though  there  were 
two  mild  epidemics  in  the  Philadelphia  Hospital  in  1866  and  in  1883;  it 
is  not  uncommon  in  England  and  Ireland.  Bad  food,  impure  air  and 
overcrowding  are  predisposing  factors. 

Incubation. — Incubation  is  placed  at  about  twelve  days,  but  may  be 
less,  and  its  duration  from  ten  days  to  two  weekso 


276  THE  EEUPTIVE  DISEASES. 

Symptoms.— The  fever  begins  abruptly  with  severe  pain  in  the  head, 
back  and  limbs;  extreme  prostration,  and  fever  which  reaches  its  maxi- 
uiuiu  (lO-i  degrees  to  105  degrees)  in  two  or  three  days.  The  temperature 
remains  high  for  about  ten  days  when  it  falls  by  crisis  (suddenly). 

The  Eruption — It  is  a  continued  fever,  attended  with  a  dark-red  or 
purplish  mottled  rash  over  the  body,  with  great  nervous  prostration,  rest- 
lessness and  delirium,  or  dullness  and  stupor,  but  without  any  specific 
affection  of  the  bowels.  The  eruption,  which  makes  its  appearance  from 
the  third  to  the  eighth  day  of  the  disease,  is  at  first  slightly  elevated  and 
disappears  when  pressed  upon  with  the  finger;  but  after  the  second  day 
from  the  time  it  comes  out,  it  is  persistent  under  pressure  and  continues 
to  show  this  character  until  it  fades,  ten  or  twelve  days  afterward. 

Fatality.- — "When  it  proves  fatal,  as  it  does  in  about  fifteen  per  cent 
of  the  cases,  death  usually  occurs  between  the  twelfth  and  twentieth  days 
of  the  attack. 

Advent  Symptoms.- — The  advent  of  the  disease  is  somewhat  gradual, 
beginning  with  general  soreness,  discomfort  and  weariness,  with  loss  of 
appetite  and  disturbed  sleep.  Shivering  and  a  feeling  of  coldness,  espe- 
cially along  the  spine,  sometimes  amounting  to  an  actual  chill,  not  un- 
frequently  mark  the  commencement  and  are  soon  followed  by  beat  of  skin, 
rise  in  temperature  and  severe  frontal  headache.  This  headache  is 
occasionally  very  severe  and  rarely  absent  at  first,  but  abates  about  the 
tenth  day. 

Disturbed  Sleep. — Slumber  is  disturbed  by  dreams,  is  unrefreshing, 
and  when  the  patient  is  not  asleep  there  is  a  constant  tendency  to  heavi- 
ness, the  mind  ceases  to  think  and  the  attention  cannot  be  concentrated 
upon  any  subject.  He  may  lie  ^vith  his  eyes  open,  evidently  not  in 
slumber,  yet  indiiferent  or  insensible  to  all  which  goes  on  around  him. 

Bodily  Weakness. — This  is  frequently  extreme,  and  the  sufferer  often 
voluntarily  takes  to  his  bed  on  the  first  day  of  his  illness.  This  exhaustion 
and  prostration  is  totally  disproportionate  to  the  amount  of  muscular 
exertion  which  has  been  made.  The  eyes,  when  examined,  are  found  to 
be  dull  and  heavy,  the  white  portion  injected  or  blood-shot  and  a  peculiar 
dusky  flush  overspreads  the  cheek. 

The  Delirium — As  the  days  pass  debility  rapidly  increases  and  de- 
lirium comes  on  the  latter  part  of  the  first  or  early  in  the  second  week. 
In  persons  of  nervous,  excitable  temperament  it  commences  sooner  and 
may  appear  on  the  third  or  fourth  night  of  the  fever,  stowing  itself 


TYPHOID  FEVER. 


277 


primarily,  perhaps,  by  a  little  conriisiou  of  thought  ou  awaking  from  a 
restless  doze. 

The  Tongue. — The  tongue  is  coated  at  first  with  a  white  fur,  but 
after  six  or  eight  days  often  may  become  dry,  swollen  and  covered  with 
thick,  brownish  crusts  of  mucus  and  cast-off  epithelial  cells,  which  make 
up  what  is  called  sordes. 

The  Bowels. — The  bowels  are,  as  a  rule,  constipated,  and  this  should 
especially  be  borne  in  mind,  because  it  forms  an  important  distinguishing 
mark  between  this  disease  and  typhoid  fever,  with  which  typhus  was 
formerly  confounded. 

The  Pulse. — The  pulse  is  quickened  from  the  outset  and  in  grave 
cases  continues  to  increase  iu  rapidity  until  it  may  more  than  double 
its  ordinary  frequency,  beating  from  one  hundred  and  forty  to  one 
hundred  and  sixty  times  per  minute. 

Complications — Broncho  pneiimonia  is  perhaps  the  most  common 
complication.  It  may  pass  on  to  gangi-ene ;  iu  certain  epidemics  gangrene 
of  the  nose,  hands  and  toes  have  occurred. 

Diagnosis. — The  diagnosis  of  typhus  fever  requires  to  be  made  in  this 
country  chiefly  from  typhoid  fever  and  relapsing  fever,  but  it  is  some- 
times difficult  to  distinguish  it  at  first  from  small-pox,  plague,  erysipelas 
and  cerebro-spinal  meningitis. 

Treatment. — As  the  treatment,  diet  and  nursing  of  typhus  fever  are 
similar  in  most  respects  to  what  is  required  in  the  far  more  common 
disease,  typhoid  fever,  the  reader  is  referred  to  our  article  upon  the  latter 
affection  for  further  information. 

Isolation. — 'ttTien  an  epidemic  of  typhus  fever  breaks  out  iu  a  crowded 
jail,  hospital  or  tenement,  the  great  cause  of  its  prevalence  should,  of 
course,  at  once  be  abolished  by  separating  those  exposed  to  it  as  widely 
as  possible  and  treating  the  sick  in  isolated  sheds,  huts  or  even  in  tents. 

TYPHOID  FEVER. 

Sjrmptoms. — Enteric  fever,  autumnal  fever  or  typhus  albuminalis. 

Definitien An  acute  infectious  disease  due  to  the  implantation  and 

proliferation  of  the  bacillus  of  Eberth,  characterized  by  ulceration  of  the 
lymph  follicles  of  the  intestines  of  the  mesenteric  glands  and  by  an  en- 
largement of  the  spleen. 

Historical The  disease  is  easy  recognizable  in  the  descriptions  of 

Hippocrates  (B.  C,  460-357)  and  Galen  (A.  D.  130-200).    Doubtless  John 


278  THE  EEUPTIVE  DISEASES. 

Hirsam's  "slow,  nervous  fever,"  described  in  his  "Essay  on  Fevers"  was 
the  typboid  of  tbe  present  day,  and  bis  "putrid  maliguaut"  tbe  yellow 
fever  of  to-day.  It  was,  however,  the  writings  and  teachings  of  tbe  great 
French  physician,  Louis,  which  did  most  to  disseminate  a  knowledge  of  tbe 
true  nature  of  typboid  fever,  to  which  he  gave  the  name  it  bears.  Among 
some  of  his  pupils  were  tbe  Americans  W.  W.  Gerhard  and  C.  W.  Pen- 
nock  of  Philadelphia  and  James  Jackson,  Jr.,  of  Boston.  To  tbe  former, 
however,  is  due  the  great  honor  of  having  first  clearly  laid  down  the 
difference  between  typboid  and  typhus. 

Causes. — Typboid  fever  prevails  in  temperate  climates  in  which  it 
constitutes  the  most  continued  fever.  It  is  widely  distributed  throughout 
all  parts  of  tbe  world. 

Seasons — It  prevails  most  in  the  autumn  months,  especially  follow- 
ing a  dry  summer. 

Sex — Males  and  females  are  equally  liable. 

Age — Typhoid  fever  is  a  disease  of  youth  and  adult  life.  The 
greatest  susceptibility  is  between  the  ages  of  fifteen  and  twenty-five.  It 
is  rare  after  sixty  and  infants  are  seldom  attacked. 

Immunity — As  in  other  fevers,  not  all  exposed  to  tbe  infection  take 
the  disease.  Some  writers  claim  that  one  attack  protects,  but  others 
claim  that  one  attack  predisposes  to  another. 

THE  BACILLI  OF  TYPHOID. 

Bacilli  in  the  Body — Tbe  bacilli  are  found  in  tbe  lymphoid  tissues  of 
the  intestines,  in  tbe  mesenteric  glands,  in  the  spleen,  liver,  bile  and  in 
tbe  bone  marrow.  They  also  occur  in  irregular  clumps  in  tbe  contents  of 
intestines  and  in  the  stools ;  they  have  also  been  f oimd  in  the  blood,  urine, 
sweat  and  sputa. 

Bacilli  Outside  the  Body — Tbe  bacilli  retain  their  vitality  in  water 
for  weeks,  but  disappear  from  ordinary  water  in  competition  with  sapro- 
pliytes  in  a  few  days.  In  milk  tbey  undergo  rapid  development  without 
changing  its  appearance.  They  may  increase  in  the  soil  and  retain  their 
vitality  for  months.  They  are  not  killed  by  freezing,  but,  as  Pruden  has 
shown,  may  live  in  ice  for  months. 

MODES  OF  CONVEYING  BACIIII. 

>£.  Contagion — The  possibility  of  tbe  direct  transmission  through  the 
air  from  one   person  to   another   must  be   acknowledged,    although,    as 


TYPHOID  FEVEE.  2^9 

shovm  by  Germano,  when  comi^letely  dried  in  air  currents,  the  siieeific 
bacillus  quickly  dies.  There  are  house  eindemics  in  which  water  and  food 
contamination  can  almost  be  excluded.  The  nurses  and  attendants  who 
have  to  do  with  the  stools  and  body  linen  of  the  patient  are  alone  liable 
to  direct  infection. 

2.  Infection  of  Water — This  is  unquestionably  the  most  common 
mode  of  conveyance.  Many  epidemics  have  been  shown  to  have  originated 
in  the  contamination  of  a  well  or  a  spring. 

3.  Milk — Milk  may  be  the  source  of  infection,  as  it  may  be  con- 
taminated in  washing  out  the  cans  with  infected  water. 

4.  Ice  and  Salads — In  addition,  the  germs  may  be  conveyed  in  ice, 
salad,  celery,  and  so  forth.  A  fly  which  has-  alighted  on  the  soiled  linen 
or  discharges  from  a  patient  may  contaminate  the  milk  or  food. 

Bad  Sewage  and  Drainage — Pilth,  bad  sewers  or  cess-pools  cannot  in 
themselves  cause  tyjjhoid  fever,  but  they  furnish  the  conditions  suitable 
for  the  presei-vation  of  the  bacillus. 

Symptoms — Typhoid  fever,  also  called  gastro-enteric  fever,  owing  to 
the  circumstance  that  the  stomach  and  intestines  are  the  chief  seats  of  the 
disease,  is  characterized  by  a  faint,  scanty  eruption  of  rose-colored  spots, 
appearing  chiefly  upon  the  abdomen,  from  the  fourth  to  the  eighth  day, 
and  coming  out  in  successive  crops.  Each  crop  of  sj^ots  continues  visible 
for  about  three  days. 

Cess-Pool  Fever — On  account  of  its  frequent  connection  with  bad 
drainage,  this  fever  has  received  the  vulgar  but  expressive  name  of  "drain 
or  cess-pool  fever,"  which,  despite  its  indelicacy,  it  would  be  well  to  per- 
petuate as  a  constant  warning  against  that  neglect  of  sanitary  arrange- 
ments in  buildings  to  which  it  is  chiefly  due. 

Initial  Symptoms. — The  onset  of  this  dangerous  and  fearfully  prev- 
alent disease  is  very  often  a  gi-adual  one.  The  patient  for  some  days  feels 
weak,  languid  and  depressed,  loses  his  appetite,  suffers  from  headache, 
and  is  restless  at  night.  In  other  cases,  however,  the  malady  begins  with 
a  slight  chill,  or  a  feeling  of  coldness  running  up  and  down  the  back,  and 
among  children  the  first  decided  symptom  may  be  an  attack  of  convulsions. 
Frequently,  too,  slight  bleeding  of  the  nose  is  noticed,  and  a  little  tend- 
ency to  looseness  of  the  bowels,  which  may  even  be  aggravated  by  errora 
in  diet,  or  other  imprudence,  into  active  diarrhoea. 

Secondary  Symptoms. — After  the  stage  of  invasion  is  completed,  the 
pulse  and  temperature  rise  steadily,  the  former  going  up  to  100  beats  or 
110   beats,   and  the  latter  ascending  to   104  degrees,   or  sometimes   105 


280  THE  EEUPTIVE  DISEASES, 

degrees  diirlng  the  first  ■week.  The  heat  of  the  body  is  almost  always 
greater  at  night  than  in  the  morning,  and  this  increment  is  so  regularly 
advanced  during  the  onset  of  the  disease,  that  it  is  quite  jjossible  for  a 
skilled  physician  to  recognize  typhoid  fever  by  a  glance  at  the  record  of 
temperature,  or  "temperature  chart,"  alone  in  many  instances. 

The  Diarrhoea. — The  diarrhcea  rapidly  grows  more  severe,  and  in  bad 
cases  is  frequently  very  profuse,  fifteen  or  twenty  thin,  watery  evacuations 
occurring  in  every  twenty-four  hours.  In  many  cases  the  bowels  are  con- 
stipated. Pain  in  the  abdomen,  especially  in  the  region  of  the  right 
flank,  is  nearly  alwaj-^  complained  of,  and  with  the  diarrhoea  is  due  to  the 
characteristic  ulceration  of  certain  oval  spots  in  the  lower  portion  of  the 
small  intestine,  which  have  received  the  names  of  Peyer's  patches.  Bron- 
chial irritation  and  cough  are  common. 

Facial  Appearance. — The  face  sometimes  wears  an  anxious,  haggard 
look,  but  frequently,  even  early  in  the  disease,  it  shows  the  dull,  indiffer- 
ent aspect,  so  often  indicating  an  oppression  of  the  brain,  which  will 
deepen  into  stupor,  then  coma  and  finally  death.  The  flush  of  the  face 
is  apt  to  have  a  more  dusky,  purplish  tint  than  in  other  fevers,  and  the 
skin  is  more  dry  and  burning,  or  pungent,  from  the  smaller  amount  of 
perspiration. 

The  Delirium — In  the  second  week  delirium  generally  comes  on,  and 
although  occasionally  violent  and  requiring  the  patient  to  be  controlled  by 
physical  force,  it  is  more  frequently  of  a  low,  muttering  character.  The 
tongue  becomes  dry  and  brown,  and  tympanites,  or  the  accumulation  of 
gas  in  the  bowels,  is  generally  considerable,  and  may  cause  by  its  enormous 
distension  great  suffering,  or  even  lead  directly  to  a  fatal  result.  Ringing 
or  buzzing  in  the  ears  with  deafness  is  very  often  noticed.  In  bad  cases 
the  diarrhoea  is  often  very  profuse,  and  discharges  of  fluid  blood,  perhaps 
in  large  quantity,  sometimes  occur  and  j^rove  quickly  fatal. 

The  Third  Week — In  the  third  week,  if  the  case  is  to  end  unfavorably, 
the  pulse  grows  frequent  and  feeble,  the  tongue  is  dry,  cracked  and  cov- 
ered with  brown  sordes,  the  delirium  and  stupor  are  constant,  involuntary 
discharges  from  the  bowels  occur,  and  the  patient  may  die  exhausted,  or 
if  the  fatal  issue  comes  earlier,  before  complete  prostration  of  muscular 
strength,  it  may  be  preceded  by  convulsions. 

Signs  of  Kecovery. — If,  on  the  contrary,  recovery  awaits  the  patient, 
the  pulse  falls  off  in  frequency,  the  temperature  gradually  diminishes,  the 
tongue  cleans  off  usually  from  the  edges,  appetite  slowly  returns  and  the 
mental  powers  are  little  by  little  regained. 


TTPHOID  FEVEE,  281 

TTnfaTorable  Symptoms. — The  unfavorable  symptoms,  besides  those 
above  mentioned,  are  an  unusually  high  temperature,  106  degrees  or  over, 
picking  at  the  bedclothes,  slipping  down  in  the  bed,  and  entreaties,  often 
of  pitiful  earnestness,  to  be  taken  home. 

Special  Features  and  Symptoms — 1.  A  severe  facial  neuralgia  may 
put  the  practitioner  off  his  guard.  In  cases  when  the  patient  has  kept 
up,  "fought  the  disease,"  the  first  manifestation  may  be  pronounced 
deliriimi.  In  rare  cases  the  disease  sets  in  with  the  most  intense  cerebro- 
spinal symptoms,  simulating  meningitis. 

2.  There  may  be  pronoimced  pulmonary  symptoms.  In  a  few  cases 
the  disease  sets  in  with  a  single  chill,  with  pain  in  the  side  and  all  the 
characteristic  features  of  lobar  pneumonia. 

3.  There  may  be  intense  gastro-intestinal  irritation.  Occasionally 
there  are  eases  with  such  intense  vomiting  and  diarrhoea  that  poisoning 
may  be  suspected. 

Fever — The  fever  has  invariably  a  step-ladder  rise ;  the  evening  tem- 
perature is  from  one  to  one  and  one-haK  degrees  higher  than  the  morning 
remission. 

Fever  of  Convalescence. — After  the  temperature  has  been  normal  for 
five  or  six  days  the  fever  may  rise  suddenly  to  102  degrees  or  103  degrees, 
and  after  persisting  from  one  to  three  or  more  days  fall  to  normal.  With 
this  condition  there  is  no  furring  of  the  tongue  and  no  distension  of  the 
abdomen.  This  condition  is  by  no  means  xmcommon,  and  is  of  especial 
importance,  as  it  is  attributed  in  most  cases  to  errors  in  diet,  constipa- 
tion, or  excitement  of  any  sort,  such  as  seeing  friends. 

Complications — 1.  Thrombosis  of  the  femoral  vein,  more  frequently 
on  the  left  side,  resulting  in  the  "milk  leg."  It  occurs,  according  to  Mur- 
chison,  in  one  per  cent,  of  all  cases.  Embolic  abscesses  may  occur  in  the 
kidneys  and  lungs. 

2.  Albuminuria  is  present  to  some  extent  in  all  severe  cases,  com- 
monly as  the  result  of  the  fever,  but  sometimes  is  the  direct  result  of  an 
acute  nephritis. 

3.  Hemorrhages  usually  occur  during  the  third  week,  and  are  indi- 
cated by  a  sudden  fall  of  temperature,  followed  by  dark  red  or  tarry  stools. 

4.  Cardiac  complications,  including  pericarditis,  endocarditis  and 
myocarditis,  are  sometimes  present.  The  latter  may  be  the  cause  of 
sudden  death. 

5.  Peritonitis  may  result  from  perforation  or  from  extension  by  con- 
tinuity j  the  former  is  more  common  and  is  recognized  by  a  sudden  pain, 


282  THE  EEUPTIVE  DISEASES. 

a  fall  of  temperature,  distension  of  the  belly  and  symptoms  of  peri- 
tonitis. 

6.  Piieuiuoiiia  may  sui^ervene  in  the  second  or  third  week  of  a  ty- 
phoid, fever,  as  a  complication,  in  which  the  true  relation  is  difficult  to 
determine. 

Diagnosis — The  diagnosis  of  typhoid  fever  must  be  made  in  its  early 
stage  from  typhus  fever,  relapsing  fever,  scarlet  fever,  measles  and  small- 
pox. At  a  more  advanced  period  it  might  be  confounded  with  the  typhoid 
condition  met  with  in  uremia  and  pyemia,  and  also  with  enteritis  or  in- 
flammation of  the  bowels,  peritonitis  or  inflammation  of  the  membrane 
covering  the  intestines,  meningitis  or  inflammation  of  the  membranes  of 
the  brain,  acute  bronchitis  or  pneumonia,  and  with  acute  consumption. 

The  Rose-Colored  Spots. — If  a  patient  who  has  been  suffering  from 
headache,  prostration,  loss  of  appetite,  restlessness  and  gradually  increas- 
ing fever,  has  a  slight  bleeding  at  the  nose  unprovoked  by  accident,  we 
may  strongly  suspect  typhoid ;  but  until  the  rose-colored  spots  appear  there 
is  no  certainty. 

Treatment — The  medical  treatment  in  typhoid  fever  miist  be  directed 
toward  mitigating  suffering,  warding  off  complications  and  obviating  the 
tendency  to  death.  In  the  early  stages  of  the  complaint  headache  is  one 
of  the  most  prominent  symptoms.  All  we  can  hope  for  is  to  procure  some 
mitigation  of  the  intense  suffering  it  frequently  occasions. 

Ice  Application. — The  application  of  ice  to  the  head,  either  in  a 
bladder  or  India-rubber  bag,  or,  what  is  still  better,  by  means  of  an  ice- 
cap, made  of  numerous  coils  of  thin  rubber  pipe,  through  which  ice-water 
is  kept  flowing,  generally  diminishes  the  pain,  which,  if  very  intense,  may 
require  the  application  of  one  of  two  leeches  behind  the  ears. 

For  Checking  Diarrhoea — Diarrhoea,  if  troublesome,  is  to  be  checked, 
but  not  stopped,  by  chalk-mixture,  bismuth-mixture  or  astringents  with 
opium,  when  necessary. 

Creosote  .-. 6  drops 

Bismuth  siibnitrate     j  drachms 

Mix  and   make   into    12  papers   and  take   one   every  three 
hours. 

Or,  when  ordinary  measures  fail — 

Silver  nitrate    5  grains 

Extract   of  gentian    4       " 

Mix  and  put  into  pills,  making  20.    Take  one  every  three 
hours. 


TYPHOID  FEVEE.  283 

Its  use,  however,  after  tbe  first  few  days,  must  be  continued  with 
great  caution,  on  account  of  permanently  blackening  the  patient's  skin. 

Rest. — Absolute  rest  in  bed,  with  the  use  of  the  bed  pan,  must  be 
enforced. 

Rendering  Stools  Innocuous — The  stools  should  be  rendered  innocu- 
ous. This  may  be  done  by  dissolving  a  pound  of  the  chloride  of  lime 
in  four  gallons  of  water.  Add  a  quart  of  this  solution  to  each  discharge 
and  allow  it  to  remain  in  the  vessel  at  least  an  hour  before  disposing  of  it. 
Soiled  bed  clothes  should  be  thoroughly  boiled. 

Restlessness — In  cases  where  restlessness  rather  than  stupor  pre- 
dominates small  doses  of  bromide  of  jiotassium  or  a  five-grain  sujiposi- 
tory  of  powdered  asafoetida  in  the  bowel  will  allay  the  condition.  When 
the  tongue  becomes  dry,  ten  drops  of  the  oil  of  turpentine  given  in  mu- 
cilage every  four  hours,  often  have  a  very  happy  effect,  and  its  influence 
upon  the  healing  of  the  intestinal  ulcerations  is  highly  lauded,  while  it 
aids  in  the  expulsion  of  the  gas. 

Stimulants. — Generally,  during  the  second  week,  sometimes  a  few 
days  earlier,  and  occasionally  a  few  days  later,  according  to  the  violence 
of  the  attack  and  the  patient's  strength  of  constitution,  it  is  advisable  to 
begin  with  the  use  of  stimulants.  The  best  indication  of  their  becoming 
needful  is  a  slight  failure  of  the  strength  of  the  pulse,  but  much  experi- 
ence is  necessary  to  judge  correctly  of  the  time,  the  quantity,  and  the 
frequency  with  which  alcohol  be  administered. 

Kinds  of  Stimulants. — At  first  half  an  ounce  of  good  whiskey  or 
brandy,  with  two  or  three  ounces  of  milk  and  half  an  ounce  of  lime-water, 
if  nausea  persists,  may  be  allowed  three  times  daily,  but  this  amount  must 
generally  be  increased  from  day  to  day,  sometimes  with  great  rapidity, 
until  in  the  worst  cases  a  pint  and  a  half  of  brandy  is  swallowed  in  twenty- 
four  hours.  Beef  tea,  beef  essence,  and  some  farinaceous  food,  such  as 
arrow-root  or  cornstarch,  ought  also  to  be  urged  upon  the  patient  at  this 
time. 

To   Stop   Hemorrhages In   cases   of  hemorrhage   fi'om  the   bowels, 

crgotin  hypodermically,  in  full  doses,  fred.  extract  of  ergot  by  the  mouth 
or  morphia  hypodermically;  aud  if  perforation  of  the  intestine,  in 
consequence  of  the  eating  through  of  one  "of  the  ulcers,  takes  place,  the 
very  slender  hope  of  recovery  is  increased  a  little  by  the  administration 
of  large  doses  of  a  gi-ain  every  hour  of  opium  and  by  secviring  perfect 
rest  in  bed. 

Hydrotherapy. — Since  many  of  the  worst  symptoms  of  typhoid  fever 


284  THE  EEDPTIVE  DISEASES. 

seem  to  be  due  to  the  effect  of  overheated  blood  upon  the  brain,  efforts 
to  reduce  the  temperature  by  the  aid  of  cool  baths  of  about  70  degrees 
Fahrenheit  six  or  eight  times  daily,  or  cold  sponging  of  the  whole  body, 
have  of  late  years  taken  a  very  prominent  place  in  the  treatment  of  the 
disease,  and  are  believed  to  reduce  markedly  its  rate  of  mortality.  Where, 
in  spite  of  judicious  emijloyment  of  means  to  bring  down  the  temperature, 
unconsciousness  continues,  great  watchfulness  is  necessary  in  regard  to 
the  evacuation  of  the  bladder,  which  may  become  dangerously  distended, 
and  even  burst  for  want  of  attention. 

Drawing  the  Urine. — When  examined  and  found  to  be  over-full,  the 
urine  should  be  at  once  drawn  oS  by  means  of  a  catheter,  and  the  opera- 
tion repeated  twice  or  thrice  every  twenty-four  hours,  imtil  the  patient 
resumes  control  over  his  functions. 

Other  treatment  would  be  the 

1.  Sponge  Bath. — The  water  should  be  cold  or  ice-cold,  according  to 
height  of  fever,  and  a  thorough  sponge  bath  should  take  from  fifteen  to 
twenty  minutes.     I  have  added  alcohol  to  the  water  with  good  results. 

2.  Cold  Pack. — If  tub  is  not  available  the  patient  may  be  wrapped  up 
in  a  sheet  wrung  out  of  water  at  60  degrees  to  65  degrees  and  then  cold 
water  sprinkled  over  him  with  a  watering  pot. 

3.  The  Bath — The  tub  should  be  long  enough  so  that  the  patient  can 
be  completely  covered,  except  his  head.  Every  third  hour,  if  tempera- 
ture is  above  102  degrees,  the  patient  is  placed  in  a  bath  at  YO  degrees 
Fahrenheit,  which,  after  the  patient  is  put  in,  can  be  lowered  a  degree 
or  two.  In  it  he  remains  for  fifteen  or  twenty  minutes.  He  is  then 
taken  out,  wrapped  up  in  a  dry  sheet  and  covered  with  a  blanket.  The 
patient's  limbs  and  body  are  gently  rubbed  while  in  the  bath,  and  on  re- 
moving he  should  have  a  stimulant.  Rectal  temperature  should  be  taken 
directly  after  the  bath,  and  again  forty-five  minutes  later.  Should  the 
patient  be  too  weak  for  the  bath,  frequent  sponging  or  Leiter's  coils  should 
be  used. 

Constipation. — Should  constipation  be  present,  though  as  a  rule  it 
does  no  harm,  it  is  well  every  third  or  fourth  day  to  give  an  enema.  If 
a  laxative  is  needed  during  the  disease  give  Hunyadi-Janos  water. 

Hemorrhage — Should  hefnorrhage  exist  it  should  be  treated  with 
full  doses  of  opium  and  acetate  of  lead.  Ice  should  be  freely  given,  and 
food  should  be  restricted  for  eight  or  ten  hours.  If  there  should  be  any 
symptoms  of  collapse  give  stimulants. 

Diet. — The  diet  of  a  typhoid  fever  patient  must  be  watched  over  with 


TYPHOID  FEVEK.  285 

unceasing  vigilance,  as  upon  it  and  proper  nursing,  more  than  upon  medi- 
cal treatment,  the  chances  of  success  often  depend.  In  the  first  stages  it 
should  be  light,  entirely  unstimulating  and  unrelaxing  to  the  bowels. 

No  Solid  Food. — Throughout  the  whole  course  of  the  disease  no  solid 
food  ought  to  be  allowed,  and  this  i^recaution  should  be  rigidly  enforced 
on  account  of  thereby  avoiding  the  risk  of  mechanically  rupturing  some 
little  hole  in  the  intestine,  at  the  seat  of  an  ulcer  which  had  almost  per- 
forated the  wall  of  the  bowel.  Such  a  catastrophe  must,  as  already 
hinted,  lead  to  almost  certain  death. 

Drink. — ^As  the  thirst  is  usually  very  great,  whilst  the  appetite  is 
nearly  lost,  it  is  a  good  plan  to  make  the  drinks  somewhat  nourishing 
in  order  to  support  the  strength.  Hence,  gum-arabic  water,  barley-water, 
albumen-water  or  milk  thickened  with  tapioca,  sago  or  cornstarch  are  often 
highly  advantageous. 

No  Fruits — If  the  usual  tendency  to  diarrhoea  is  at  all  marked,  fiiiits 
of  all  kinds  ought  to  be  entirely  withheld  by  the  nurse,  and  even  where 
the  bowels  are  not  disordered,  fruits  and  vegetables,  other  than  those 
enumerated,  should  be  very  cautiously  given,  on  account  of  the  disposi- 
tion to  looseness  of  the  bowels  which  generally  exists.  Many  cases  of 
death  from  typhoid  fever  may  be  directly  traced  to  the  murderous  impru- 
dence of  nurses  and  attendants  in  this  respect. 

Diet  for  Second  Week. — During  the  second  week,  when  slight  indica- 
tions of  debility  iisually  begin  to  manifest  themselves,  a  more  nutritious 
diet  becomes  necessary.  Thicker  preparations  of  the  farinaceous  foods 
above  mentioned  should  be  employed,  beef  tea  and  beef  essence  may  be 
added  to  the  list,  and  as  debility  increases  eggs  beaten  up  with  milk, 
flavored  perhaps  with  a  little  wine,  if  they  have  been  well  borne  during 
health,  may  be  administered.  In  the  latter  stages,  when  the  whole 
capacity  of  the  enfeebled  digestive  organs  is  needed  to  take  up  sufficient 
food  to  sustain  life,  strong  meat-soup,  beef  essence,  eggs  beaten  up  with 
•wine,  and  milk  punch  should  alone  be  urged  upon  the  patient. 

Injected  Food Life  has  apparently  been  saved  in  some  instances  by 

frequently  repeated  small  injections  of  beef  essence,  brandy  and  milk,  with 
a  few  drops  of  laudanum,  in  order  to  prevent  the  enema  from  being 
rejected  from  the  bowels,  as  is  often  the  case  in  spite  of  all  our  efforts. 

Nursing. — In  nursing  the  case  of  a  typhoid  fever  patient,  v/atchful 
and  judicious  care  of  a  skillful  attendant  often  contributes  in  those  in- 
stances having  a  favorable  termination,  as  m.ost  candid  physicians  will 
admit,  more  than  medical  treatment  to  the  sick  man's  recovery.     The 


gSG  THE  EEUPTIVE  DISEASES. 

suitable  administration  of  medicines  to  control  diarrhoea,  according  to  the 
varying  j)hases  of  that  important  symptom;  to  relieve  restlessness  and 
allay  excitement;  the  proper  employment  of  baths  to  reduce  febrile  heat 
and  diminish  cerebral  congestion ;  the  constant  guarding  of  the  patient 
from  injurious  articles  of  food;  the  increasing  effort  to  economize  the 
failing  strength,  which  otherwise  may  prove  just  a  little  lacking  in  the 
last  great  day  of  struggle  with  the  disease,  notwithstanding  all  the  rein- 
forcements called  upon  in  the  way  of  stimulants  and  nutrients  to  support 
it,  ail  these  oifer  an  ample  field  for  the  highest  intelligence  and  the  noblest 
self-sacrifice. 

Watching  the  Delirium. — The  attendant  upon  a  typhoid  fever  case 
must  be  on  his  guard,  lest  in  his  momentary  absence  the  delirious  patient 
gets  out  of  bed  and  attempts  to  escape  from  the  house,  or  perhaps  throws 
himself  out  of  a  window.  Even  the  effort  at  walking  across  the  room 
may,  in  the  weak  conditions  met  with  in  the  latter  portion  of  the  fever,  so 
exhaust  the  failing  strength  as  to  load  to  dangerous  or  fatal  collapse. 

Treating  Bed-Sores. — The  tendency  to  bed-sores,  which  are  particu- 
larly apt  to  form  over  the  portions  of  the  body  pressed  upon  in  lying  upon 
the  back  during  typhoid  and  typhus  fevers,  must  be  overcome,  as  far  as 
possible,  by  frequent  change  of  position,  the  use  of  perforated  pillows  or 
cushions  and  of  water-beds,  and  the  patient  should  be  well  rubbed  with 
alcohol  twice  a  day,  especial  care  being  used  over  the  parts  of  the  body 
that  the  patient  rests  on  while  in  bed,  i.  e.,  back,  buttock,  and  so  forth. 
As  a  general  rule,  the  formation  of  a  bed-sore  in  a  case  of  typhoid  fever 
not  lasting  more  than  twenty-five  to  thirty  days,  is  evidence  of  care- 
lessness on  the  part  of  the  nurse,  and  should  never  bo  permitted  to  occTir. 
"When  once  developed,  bed-sores  must  be  kept  clean  and  carefully  dressed 
once  or  twice  daily,  in  the  hope  of  preventing  them  from  spreading,  as 
the  chance  of  curing  them  until  the  patient  can  sit  up  Is  exceedingly  small. 
Not  only  Is  the  suffering  from  bed-sores  very  great,  but  the  free  discharge 
of  pus  which  they  generally  yield  is  extremely  debilitating  and  quickly 
exhausts  the  little  remaining  stock  of  strength. 

Typhoid  Mortality.— The  mortality  of  typhoid  fever  varies  in  differ- 
ent epidemics  from  10  to  20  per  cent.  The  older  the  patient  the  less  is 
his  chance  of  recovery  from  the  malady,  whilst  among  children  the  pro- 
portion of  deaths  is  quite  small. 

Walking  Typhoid. — Some  of  the  mildest  cases,  those  to  which  the 
name  of  "walking  typhoid"  has  been  appropriately  applied,  may  suddenly 
terminate  in  perforation  of  the  bowel,  and  death  in  a  few  hours  from 


SPOTTED  FEVEE.  287 

collapse  or  from  peritonitis.  On  this  account  a  typhoid  fever  patient,  no 
matter  how  slight  his  symptoms  of  illness  may  be,  should  stay  in  bed,  and 
swallow  nothing  but  liquid  food,  until  the  searching  test  of  the  ther- 
mometer shows  that  all  febrile  movement  has  subsided. 

Management  of  Convalescence — Even  after  convalescence  has  fairly 
set  in,  great  watchfulness  is  necessary.  Permission  to  sit  up  in  bed  even 
ought  not  to  be  given  until  several  days  have  passed  without  any  fever, 
as  proved  by  the  thermometer,  which  should  be  used  morning  and  evening 
throughout  the  complaint,  and  the  return  to  solid  food  must  be  both  slow 
and  gradual.  Any  imprudence  in  diet,  or  slight  over-exertion,  may  bring 
on  a  relapse,  which  is  much  worse  than  the  original  attack,  and  its  causes 
ought  therefore  to  be  most  sedulously  shunned. 

Prevention  of  Typhoid. — The  great  means  of  preventing  typhoid  fever 
by  unceasing  vigilance  in  regard  to  the  purity  of  the  water,  milk  and  air 
supply  has  already  been  urgently  insisted  on.  Prevention  of  typhoid  is 
now  being  carried  out  in  the  army  and  institutions  by  means  of  hypo- 
dermic injections  of  bacterius. 

CEREBRO-SPINAL  FEVER  OR  SPOTTED  FEVER. 

Definition. — An  infectious  disease  occurring  sporadically  and  in  epi- 
demics, caused  by  a  diplococcus,  characterized  by  an  inflammation  of 
the  cerebro-sjjinal  meninges  and  symptoms  of  great  pain  in  the  head,  back 
and  limbs,  convulsions,  irregular  fever,  and  at  times  petechial  eruption. 

History. — In  1801  Vieussens  first  described  a  small  outbreak  in 
Geneva.  There  had  been  several  outbreaks  in  the  United  States  prior  to 
1875,  but  since  that  time  there  have  been  several  extensive  epidemics. 
There  was  a  serious  epidemic  in  Western  Maryland  in  1892,  in  New 
York  in  1893,  and  from  the  spring  of  1896  to  the  spring  of  1898  the  dis- 
ease has  prevailed  extensively  in  Boston  and  its  neighboring  towns. 

Causes — Over-crowding,  poor  food,  foul  air  and  bad  drinking  water 
seem  to  be  the  predisposing  causes.  The  epidemics  have  occurred  most 
frequently  in  winter  and  spring.  The  concentration  of  individuals,  as  of 
troops  in  barracks,  seems  to  be  a  special  factor;  in  civil  life  children  and 
young  adults  seem  most  susceptible. 

Symptoms — Many  different  forms  have  been  described,  but  they  are 
best  grouped  into  three  classes : 

1.  Ordinary  Form. — This  is  a  malignant  epidemic  fever,  usually  at- 
tended with  painful  contraction  of  the  muscles  of  the  neck  and  retraction 


288 


THE  EEtfPTIVE  DISEASES. 


of  the  head,  and  frequently  accompanied  by  a  profuse  purpuric  eruption. 
It  is  a  disease  which  generally  comes  on  suddenly,  runs  its  course  with 
great  rapidity,  and  proves  fatal  in  a  majority  of  instances.  The  malady 
is  more  than  a  mere  inflammation  of  the  membranes  of  the  brain,  or 
meningitis,  for  the  whole  nervous  system  seems  to  be  very  gravely  affected 
from  the  first- 
Premonitory  Symptoms — Premonitory  symptoms  are  rare,  but  when 
they  are  met  with,  show  themselves  simply  as  slight  headache  and  pain 
in  the  back,  or  a  little  uneasiness  and  weariness  experienced  for  several 
days  before  acute  symptoms  set  in.  These  may  commence  with  a  chill  or 
marked  shivering-fit,  followed  by  intense  vertigo,  headache  of  intolerable 
severity,  obstinate  and  violent  vomiting,  painful  muscular  stiffness,  soon 
developing  into  continuous  spasms,  affecting  particularly  the  muscles  of 
the  head  and  back. 

Head  Distress Distress  in  the  head  is  constant  so  long  as  conscious- 
ness lasts.  The  eyes  are  blood-shot,  and  express  agonizing  suffering,  the 
pupils  are  contracted,  and  the  countenance  is  pale.  Excessive  restlessness 
and  general  muscular  agitation  prevail,  and  the  sensibility  of  the  whole 
surface  is  so  great  that  every  touch  and  movement  causes  excruciating 
pain,  and  even  touching  the  hair  is  painful. 

Third  Day  Symptoms — These  symptoms  increase  up  to  the  third  or 
fourth  day,  when  the  power  of  swallowing  begins  to  be  affected,  and  the 
process  of  respiration  to  be  imperfectly  and  irregularly  performed,  the 
head  being  dragged  tightly  back  as  far  as  possible,  and  the  features  fixed 
in  the  horrible  and  characteristic  gTin  of  lockjaw.  The  delirium  usually 
developed  during  the  third  day,  if  it  has  not  sooner  appeared,  passes  into 
stupor,  and  this  in  its  turn  deepens  into  coma,  from  which  or  from  suf- 
focation death  commonly  releases  the  sufferer  between  the  fifth  and  eighth 
day  of  the  complaint,  or  in  a  few  cases  the  patient  may  gradually  improve, 
and  after  three  or  four  weeks  enter  upon  a  tedious  convalescence  of  many 
months'  duration. 

2,  Malignant  Perm There  is  an  abrupt  onset  with  a  chill,  followed 

by  vomiting,  headache,  moderate  fever,  convulsions  and  rash. 

3.  Abortive  Perm The  disease  begins  abruptly  with  grave   sym- 

toms,  but  terminates  in  a  few  days  in  recovery. 

Diagnosis. — The  diagnosis  between  this  disease — which,  it  should  be 
stated,  has  also  been  named  epidemic  cerebro-spinal  meningitis,  or  pur- 
puric fever — and  typhus  fever,  typhoid  fever,  tetanus  or  lockjaw,  tuber- 
cular meningitis  and  typhoid  pneumonia,  is  usually  not  difficult,  except  in 


SPOTTED    FEVEE.  289 

the  earliest  stages.  The  fact  of  its  epidemic  prevalence  generally  aids  at 
once  to  its  recognition,  except  in  the  first  few  eases  which  occur,  and  even 
in  these  the  intolerable  headache,  retraction  of  the  head,  and  excessive 
sensitiveness  of  even  the  hair  to  the  lightest  touch,  are  almost  always  suffi- 
cient to  characterize  this  strange  and  terrible  malady. 

Complications — Deceptive  vision  from  inflammation  of  the  cornea 
or  atrophy  of  the  optic  nerve ;  defective  hearing  from  inflammation  of  the 
auditory  nerve  or  from  suppurative  inflammation  of  the  middle  ear. 
Pleurisy,  pericarditis  and  parotitis  are  not  uncommon,  and  headaches  more 
or  less  severe  may  remain  for  months  or  years. 

Treatment — The  treatment  consists  of  dry  or  wet  cups  to  the  nape  of 
the  neck  and  along  the  spine,  cold  to  the  head  hy  means  of  ice-bags  or 
bladders,  or  better  still  the  ice-cap,  opium  in  quantities  of  a  grain  every 
two  or  three  hours,  and  especially  hypodermic  injections  of  morphia,  to 
relieve  the  agonizing  sufi^ering  as  well  as  for  the  direct  curative  effect 
■which  opiates  seem  to  possess  in  some  instances,  and  iodide  of  potassium, 
in  full  doses  of  five  grains  every  four  hours,  is  indicated  during  con- 
valescence, and  blisters  to  the  spine  are  also  highly  recommended. 

General  Remarks  as  to  Prevention — Cerebro-spinal  Meningitis  is  a 
very  contagious  disease  with  a  very  high  death  rate.  Death  may  occur 
"within  a  few  hours  to  a  few  days.  It  is  caused  by  a  germ  which  is  foimd 
in  the  fluid  in  the  spinal  cord. 

Outbreaks  are  more  common  in  the  winter  and  spring  than  in  warm 
weather.  It  occurs  both  in  large  cities  and  sparsely  settled  country  places. 
Its  development  is  favored  by  the  presence  of  filth,  exposure  to  cold  and 
wet,  overwork,  injury  to  the  head,  etc.  Individuals  of  all  occupations 
and  professions  can  catch  this  disease.  Its  danger  lies  in  its  being  a  dis- 
ease especially  of  children  and  young  adults.  After  forty  years  of  age  it 
is  rare,  though  in  a  severe  epidemic  anyone  is  liable  to  catch  it. 

The  early  symptoms  of  cerebro-spinal  meningitis  consist  of  a  child 
or  adult  being  seized  with  a  violent  headache,  chill,  nausea  and  vomiting. 
The  patient  is  dizzy  and  acts  like  a  drunken  person.  Dragging  pains  occur 
in  the  neck  which  extend  along  the  spine  and  into  tlie  legs  and  arms. 
The  patient  suffers  agonizing  pain  upon  bending  the  head  forward  or  from 
side  to  side.  Later  convulsions  develop,  and  the  patient  becomes  rigid, 
with  only  the  back  of  his  head  and  heels  touching  the  bed.  The  back  is 
arched,  eyes  may  be  crossed  and  bulging  and  he  presents  a  terrible  and 
hopeless  picture  of  suffering  and  despair.  The  slightest  touch  will  pro- 
X9 


290  THE  EETJPTIVE  DISEASES. 

duce  pain  and  cause  the  patient  to  utter  terrifying  screams.  Delirium 
develops,  followed  by  stupor,  and  unles  the  patient  has  a  good  consti- 
tution and  receives  special  care  and  treatment,  death  follows. 

The  rash  of  spotted  fevers  occurs  as  tiny  scattered  reddish  spots,  some 
are  dark  or  purplish  red  and  contain,  when  stuck  with  a  needle,  a  reddish 
fluid.    In  the  severe  cases  death  may  occur  in  a  few  hours. 

The  germ  causing  this  disease  is  supposed  to  enter  the  body  through 
the  mouth  and  nose  and  finally  reaches  the  brain  and  spinal  cord. 

The  after  effects  of  spotted  fever  are  what  makes  the  disease  so  dan- 
gerous. Thus  various  fonns  of  paralysis,  loss  of  intelligence,  due  to  the 
brain  having  been  inflamed  (meningitis),  complete  deafness  and  loss  of 
yision. 

The  spread  of  the  disease  can  be  prevented  by  a  person  following  the 
laws  of  personal  cleanliness,  and  removing  all  filth,  dust,  etc.,  from  about 
the  premises.  Avoid  catching  a  cold,  and  do  not  approach  a  house  where 
a  ease  is. 

Every  ease  of  spotted  fever  must  be  reported  to  the  health  authorities 
by  the  physician  or  guardian  of  the  patient.  Don't  wait  a  minute.  If 
there  is  a  case  in  your  neighborhood,  be  on  guard  and  at  the  slightest 
sign  of  any  child  or  young  adult  being  taken  ill  with  the  symptoms,  men- 
tion the  above,  summon  your  physician  or  the  nearest  health  authority. 

The  patient  must  be  placed  in  a  darkened,  well-ventilated  room. 
Screen  all  doors  and  windows.  The  attendant  or  nurse  must  not  leave 
the  room  without  leaving  the  clothing  inside  and  the  hands  must  be 
dipped  in  chloride  of  lime. 

The  Board  of  Health  will  place  a  placard  on  the  front  and  back 
doors.  Whenever  possible,  send  the  patient  to  the  contagious  hospital. 
All  bed  linen,  clothing,  dishes,  etc.,  must  be  dipped  in  chloride  of  lime 
solution  (onc-lialf  pound  to  a  pail  of  water)  before  being  washed.  All 
cloths  in  which  the  discharges  from  the  nose  and  throat  have  been  collected 
must  be  burned.  The  kissing  of  patients  is  dangerous  as  the  disease  may 
be  contracted  in  this  manner.  No  one  must  enter  or  leave  the  room  in 
■which  the  patient  is  confined  except  the  doctor  or  nurse. 

After  recovery,  the  room  must  be  fumigated  by  the  Board  of  Health. 
Leave  in  the  room  all  clothing  worn  by  the  j^atient  and  nurse,  bed  linen, 
carjjets,  Curtains,  etc.,  must  be  spread  out  so  that  the  disinfectant  can 
destroy  all  germs.  Kill  all  flies  or  mosquitoes  seen  in  or  about  the  room 
or  house,  as  they  cavij  the  diseasCt 


BELAPSINQ  FEVEB.  291 


KEIAPSING  FEVEH  OB,  FEBRIS  RECTTRKENS. 

Definition. — It  is  an  infectious  disease  caused  by  tlie  spirochetes  of 
Obenueier,  characterized  by  a  delinite  febrile  paroxysm  which  usually 
lasts  six  days,  and  is  followed  by  a  remission  of  the  same  length  of  time, 
then  by  a  second  paroxysm,  which  may  be  repeated  three  or  four  times. 

Cause. — This  disease  is  also  kno\^Ta  as  "famine  fever"  and  "seven- 
day  fever."  The  special  conditions  under  which  it  develops  are  similar 
to  those  of  typhus  fever. 

Symptoms — Period  of  incubation  appears  to  be  short  and  in  some 
cases  the  attack  develops  promptly  after  exposure,  more  frequently,  how- 
ever, from  five  to  eight  days.  Its  onset  is  usually  abrupt,  without  any 
preliminary  symptoms,  and  the  febrile  attacks,  usually  severe  though  of 
short  duration,  pass  away  leaving  the  patient  comjiaratively  well  for  a  few 
days.  After  an  interval  of  about  a  week,  however,  a  repetition  of  the 
primary  attack  is  experienced,  and  this  relapse,  from  which  the  disease 
takes  its  name,  may  recur  four  or  even  five  times. 

Blood  Germs — Eelapsing  fever  is  remarkable  for.  being  the  firsti 
human  febrile  affection  of  a  paroxysmal  character  which  has  been  defi- 
nitely connected  with  the  development  of  a  vegetable  organism  in  the 
blood.  The  peculiar  vegetable  organisms  belonging  to  the  spirochetes  are 
found  in  the  blood  of  relapsing  fever  patients  by  tens  of  thousands,  and 
disappear  during  the  temporary  convalescence,  to  reappear  with  the  recur- 
rence of  the  febrile  attack. 

Symptoms  Beginning — The  onset  of  the  malady  is  marked  by  a  chill 
or  shivering-fit,  severe  headache,  vomiting  and  often  jaundice;  a  white, 
moist  tongue,  tenderness  over  the  pit  of  the  stomach,  constipation,  en- 
larged liver  and  spleen,  high-colored  urine,  a  frequent,  full  and  often 
bounding  pulse,  pains  in  the  back  and  limbs,  and  frequently  delirium. 

Further  Symptoms. — These  symptoms  abruptly  terminate  between 
the  fifth  and  eighth  day,  as  a  general  rule,  by  an  exceedingly  copious 
perspiration,  and,  after  an  interval  of  a  week,  during  which  it  may  be  sup- 
posed that  a  new  crop  of  bacteria  are  ripening,  and  in  which  time  the 
patient  is  often  well  enough  to  get  up  and  walk  about,  a  sudden  relapse 
takes  place,  running  through  the  same  phases  as  the  original  outbreak, 
except,  perhaps,  that  it  is  a  little  shorter. 

At  Death.--^When  death  occurs,  it  is  apt  to  happen  from  a  fainting- 
fit, following  excessive  perspiration,  or  from  coma,  the  result  of  suppres- 


292  TUE   EEDPTIVE   DISEASES. 

sion  of  the  renal  secretion,  but  as  seen  in  America  the  fatality  is  verj 
small,  Itping;  on  an  average  less  than  two  per  cent. 

Diagnosis. — The  diagnosis  of  relapsing  fever  cannot  bo  positively 
made  by  the  general  symptoms  during  tlic  primary  onset,  but  may  be 
strongly  suspected,  and  the  relapse  looked  for  if  the  disease  is  jirevailing, 
and  exposure  to  the  contagion  has  occurred.  A  microscopic  examination 
of  the  blood  dviring  the  height  of  the  febrile  movement  Avill,  however, 
determine  the  presence  of  the  spiro-baeteria,  and  this  investigation  ought 
therefore  always  to  bo  made. 

1.  Treatment. — Although  so  far  advanced  in  our  knowledge  in  regard 
to  the  vegetable  nature  of  the  triie  contagion  of  relapsing  fever,  we  have 
not  yet  made  equal  progi-ess  in  the  specific  treatment  of  this  complaint. 
The  great  problem,  of  course,  is  to  find  some  mineral  siibstance  which  can 
be  taken  up  in  the  blood  in  sufficient  quantities  to  check  or  pi'event  the 
growth  of  the  bacteria  in  that  vital  lliiid,  without  seriously  injuring  the 
patient  himself.  Quinine,  so  useful  in  intermittent  fever,  has  proved  al- 
most worthless  in  this  disease,  and  our  chief  reliance  to  reduce  the  high 
temperature  is  at  present  on  cool  baths  or  cold  sponging. 

2.  For  the  Headache — If  the  headache  Is  very  severe,  dry  cups  to  the 
back  of  the  neck  and  ;ilong  the  spine  may  be  employed,  or  one  or  two 
leeches  may  l)e  applied  behind  the  ears,  although,  since  the  tendency  of 
the  disease  is  toward  great  debility,  it  is  better  to  avoid  the  abstraction 
of  blood  if  possible.  Opium  or  morphia  by  the  stomach,  or  still  better  by 
hypodermic  injection,  is  often  necessary  to  relieve  the  headache  and  the 
severe  pain  in  the  limbs,  and  If  symptoms  of  prostration  come  on  early, 
wine  or  brandy  must  be  resorted  to. 

3.  The  TJrine — A  very  careful  watch  must  be  maintained  over  the 
functions  of  the  kidneys,  since  one  of  the  great  dangers  of  the  disease 
appears  to  be  the  failure  of  these  organs  to  jierforra  their  duty  of  purify- 
ing the  blood  from  urea,  wliicli,  when  allowed  by  renal  negligence  to 
accumulate  In  the  system  frequently  causes  death  by  uremic  poisoning. 
The  urine  should,  therefore,  be  frequently  examined,  its  total  daily 
quantity  noted,  and  the  existence  of  albumen  tested  for.  On  account  of 
its  favorable  action  on  the  kidneys,  sweet  spirits  of  nitre  in  quantities  of 
a  teaspoonful  every  four  hours  Is  ]inrticularly  applicable. 

4.  For  the  Pain — For  the  muscular  pains  it  is  reasonable  to  expect 
that  phenacetlne,  antifebrin  or  antljiyrlu  will  be  of  great  service.  The 
febrile  paroxysm  demands  much  the  same  treatment  as  typhus  fever. 
Sponging  or  cold  baths  and  nutritious  and  easily  assimilated  food. 


FEBEICULA   OK  EPHEMERAL   FEVER.  293 


FEBKICULA  OR  EPHEMERAL  FEVER. 

Definition — A  fever  of  short  duration,  depending  on  a  variety  of 
irritative  causes.  A  febrile  movement,  lasting  twenty-four  hours  and  then 
^disappearing,  may  for  convenience  he  called  ephemeral  fever;  if  of  three 
or  four  days'  duration,  febricula. 

Causes — The  most  frequent  cause  of  this  form  of  fever  is  probably 
the  ingestion  of  foods  difficult  of  digestion.  As  a  rule  dyspepsia  is  per- 
haps the  most  frequent  cause  of  such  a  fever.  This  is  especially  the  case 
with  children,  where  it  is  often  spoken  of  as  gastric  fever.  Another 
cause  is  exposure  to  cold,  insufficient  to  produce  bronchitis,  tonsilitis  or 
some  other  affection  too  slight  to  be  recognized  by  the  usual  signs. 

Symptoms. — The  symptoms  of  irritative  fever  are  those  usual  to  fever 
in  a  mild  degree,  i.  e.,  moderate  elevation  of  temperature  rarely  above 
103  degree  Fahrenheit,  frequent  pulse,  flushed  face,  headache,  sense  of 
lassitude  and  weariness,  loss  of  appetite,  nausea  aud  restlessness ;  in  chil- 
dren perhaps  delirium.  The  fever  is  apt  to  terminate  suddenly  by  crisis 
on  the  third  or  fourth  day. 

Diagnosis. — Typhoid  fever — at  first  the  diagnosis  may  be  impossible, 
but  the  absence  of  diarrhoea,  tympanites,  abdominal  tenderness,  spleeniff 
enlargement  and  eruption  will  soon  nuike  the  diagnosis  apparent. 

Treatment. — Absolute  rest  in  bed,  a  li(iuid  diet  and  rejieated  doses 
of  calomel  may  be  employed  to  relieve  the  constipation.  The  fever  may 
be  controlled  by  the  following  mixture : 


Tincture  of  aconite  root   3  drops 

Spirits  of  nitrous  ether    'i!  ounce 

Acetate  of  liquid  ammonia,  add  sufficient  to  make  3  fluidounces. 
A  dessertspoonful  every  two  hours  for  a  child  4  years  old. 


PROTRACTED  SIMPLE  CONTINUED  FEVER. 

Definition  and  Cause. — It  seems  necessary  for  the  present  to  continue 
this  term  for  a  feverish  process  of  a  longer  duration  than  febricula — a 
fever  of  long  duration  that  is  not  typhoid,  nor  influenza — lasting  from  two 
weeks  to  three  months  and  without  definite  lesions  may  be  put  under  this 
head.  Cases  of  prolonged  fever  succeeding  pneumonia  and  pleurisy  which 
subsequently  recover  may  well  be  ascribed  to  this  disease. 


294  THE  EEUPTIVE  DISEASES. 

Symptoms  are,  as  will  be  readily  understood  from  tliis  explanation, 
slight  cliill  or  chilly  feelings  for  the  initial  disturbance,  followed  in  a  few 
hours  by  headache,  quickened  pulse,  rise  in  temperature  and  constipation. 
Very  often  in  persons  of  sensitive  stomachs  there  is  a  little  nausea  or 
vomiting  for  twelve  or  twenty-four  hours,  and  again  with  those  of  sensitive 
skins  there  may  be  a  slight  eruption  of  roseola,  or  prickly-heat,  as  it  is 
often  called,  especially  about  the  loins  and  over  the  back.  The  fever  may 
run  high  enough  for  the  overheated  blood  to  disturb  the  brain  and  pro- 
duce some  delirium,  especially  at  night ;  but  at  the  end  of  a  period,  vary- 
ing in  duration  from  twelve  hours  to  ten  days,  the  febrile  symptoms 
usually  subside  without  any  further  derangement  of  the  system  than  a 
very  copious  and  debilitating  perspiration,  or  perhaps  an  outbreak  of  the 
vesicles  of  herpes,  commonly  denominated  "cold  sores,"  about  the  face 
or  elsewhere.  Such  attacks  as  these  cause  much  needless  anxiety,  needless 
at  least  in  the  aSTorthern  States,  to  both  physicians  and  patients,  the  former 
dreading  the  onset  of  tyj^hoid  fever  or  other  dangerous  disease,  and  the 
latter  suffering  an  agony  of  suspense  from  which,  for  a  time,  all  the 
knowledge  of  Hippocrates  or  ^sculapius  himself  could  not  deliver  them. 

Treatment — The  patient  in  these  puzzling  cases  should  be  kept  in 
bed,  and  allowed  only  light  and  unstimulatlng  liquid  food.  Cold  applica- 
tions may  be  made  to  the  forehead  and  temples  to  relieve  headache,  and 
diaphoretics  combined  with  anodynes,  such  as  nitre  and  morphia,  as  al- 
ready directed,  to  reduce  fever  and  allay  restlessness.  Lumps  of  ice  are 
useful  and  refreshing  to  the  throat  when  swallowed  and  whilst  there 
is  constipation  small  doses  of  calomel  repeated  until  there  is  a  free  bowel 
movement. 

YELLOW  FEVEE. 

These  germs,  in  the  course  of  ten  to  fourteen  days,  undergo  a  process 
of  development  and  multiplication.  At  the  end  of  the  period  of  develop- 
ment the  germs  migrate  to  the  biting  organ  of  the  mosquito,  from  where 
they  are  transmitted  into  the  blood  of  a  healthy  person  through  the  skin, 
"when  bitten.  Each  germ,  in  turn,  when  deposited  in  the  blood  vessel  of 
the  human  body,  multiplies  and  develops,  and,  liberating  its  toxin,  spreads 
through  the  circulation  and  produces  the  yellow  fever  in  it  most  pro- 
nounced form. 

Yellow  Fever,  sometimes  called  Yellow  Jack,  Sailor's  Fever,  Black 
Vomit,  Gibraltar  Fever,  etc.,  is  a  disease  occurring  in  tropical  and  sub- 
tropical countries.    Its  cause  is  unknown,  but  science  has  proven  that  the 


TELLOW  FEVEE. 


295 


poison  causing  Yellow  Fever  is  carried  from  one  sufferer  to  another  by 
the  mosquito  called  the  Stegomyia  fasciata. 

Yellow  Fever  is  sujiposed  to  have  been  imported  into  the  Western 
Hemisphere  by  the  Spanish  navagitors.  It  was  first  described  as  a  dis- 
ease in  the  middle  of  the  seventeenth  century,  where  it  was  discovered  in 


THE   YELLOW    FEVEE   MOSQUITO. 


the  Antilles.  The  disease  affects  seaport  towns  and  maritime  districts  in 
tropical  and  subtropical  coimtries.  Epidemics  occurred  in  the  seaport 
cities  of  the  United  States  in  the  nineteenth  century.  Philadelphia  suf- 
fered from  a  disastrous  epidemic  during  the  end  of  the  eighteenth 
century. 


296  ITHE  ERtTPTlVE  DISEASES. 

Yellow  Fnver  always  oociirs  in  tlie  summer  and  autumn  months  and 
ends  uiion  the  appearance  of  frost.  Havana,  Cuba,  Vera  Cruz,  Mexico; 
Rio  Janeiro,  Brazil,  and  ITew  Orleans  during  the  nineteenth  century,  until 
the  occupation  of  Cuba  by  the  Americans,  were  the  cities  known  as  the 
spots  in  whick  Yellow  Eevcr  was  usually  present,  and  from  which  the 
disease  spread  to  other  seaport  cities  of  tropical  and  subtropical  coun- 
tries and  the  United  States. 

The  Mosquito  as  the  Carrier  of  Yellow  Fever Dr.  Finlay,  of  Havana, 

in  ISSl  first  called  attention  to  the  fact  that  the  mosquito  was  associated 
■with  Yellow  Fever,  and  about  1890  was  the  first  to  explain  clearly  the 
mosquito  theory  of  the  transmission  of  Yellow  Fever,  but  he  could  not 
prove  it  at  the  time  by  experiment. 

The  American  occnjiation  of  Cuba,  however,  brought  into  application 
in  a  practical  way  this  theory  of  Dr.  Finlay's.  Thousands  of  cases  of 
Yellow  Fever  occurred  throughout  the  island  and  became  a  menace  to  the 
health  and  lives  of  our  troops.  This  brought  home  to  the  United  States 
Government  the  dangers  and  prevalence  of  Y'^ellow  Fever  in  so  close  a 
neighbor,  and  renewed  efforts  were  made  to  prove  that  the  mosquito  car- 
ried the  poison  which  caused  Yellow  Fever. 

In  1-900  Dr.  Finlay  had  produced  yellow  fever  in  a  man  by  allowing 
a  mosquito  to  bite  him  two  days  after  the  insect  had  bitten  a  suiferer 
from  Yellow  Fever.  This  lead  to  experiments  carried  on  by  the  U.  S. 
Yellow  Fever  Commission,  which  confirmed,  -without  doubt,  that  the  mos- 
quito (Stcgomi/ia  fasciata)  spreads  the  Yellow  Fever.  This  Commission 
had  a  mosquito-proof  house  built  with  a  partition  dividing  it  into  two 
rooms.  Into  one  room  was  placed  a  non-immune  person  in  a  bed  and  mos- 
quitoes which  had  previously  bitten  Yellow  Fever  patients  were  liberated. 
They  attacked  and  bit  the  vohmteer,  who  had  purposely  exposed  his  arms 
and  chest.  This  procedure  was  repeated  three  successive  times.  Five 
days  after  this  experiment,  this  man  developed  Yellow  Fever.  On  the 
evening  that  this  first  man  exposed  himself  to  the  mosquito,  two  other  men 
■who  never  had  Yellow  Fever  slept  in  the  second  room,  which  was  screened 
and  contained  no  mosquitoes,  and  they  did  not  catch  the  disease  from  the 
man  in  the  adjoininp-  room;  this  experiment  proving  that  the  disease 
could  not  be  caught  by  being  near  or  in  contact  with  a  patient. 

A  second  mosquito-proof  house  was  constructed  in  which  bed- 
clothing  and  wearing  apparel  which  had  been  soaked  in  the  discharges 
from  a  sufferer  from  Yellow  Fever,  were  placed,  and  this  house  was  en- 
tered for  twenty-one  consecutive  nights  by  two  soldiers  and  a  surgeon 


YELLOW  FEVEE.  297 

•who  handled  and  shook  the  soiled  articles.  This  experiment  was  repeated 
by  three  dili'erent  sets  of  men,  each  remaining  twenty-one  nights.  Not  a 
man  contracted  Yellow  Fever,  nor  was  any  the  worse  for  the  experiment. 
This  experiraent  proved  that  Yellow  Fever  was  not  contagious  and  could 
not  be  caught  by  the  handling  of  clothes,  etc.,  fi-om  a  patient  who  had 
Yellow  Fever. 

The  absolute  proof  that  Yellow  Fever  was  carried  by  the  mosquito 
was  put  to  a  practical  test  by  Dr.  Gorgas,  of  the  U.  S.  Army,  who  in  the 
cleaning  of  Havana  destroyed  every  mosquito  seen,  cleared  away  all  breed- 
ing phicps  and  screened  all  homes,  hospitals  and  camps  where  Yellow 
Fever  patients  were  confined.  Thus  Havana  was  made  as  free  from  Yel- 
low Fever  and  as  safe  to  live  in  as  the  healthiest  city  in  the  world. 

It  requires  three  to  four  days  for  a  person  to  develop  Yellow  Fever 
after  being  l)itten  liy  a  mosquito  which  has  sucked  the  blood  of  a  patient 
suffci'ing  from  the  disease.  Experiments  have  proven  that  the  mosquito 
cannot  convey  the  disease  to  another  until  he  has  bad  the  poison  in  his 
body  for  twelve  days  after  biting  a  Yellow  Fever  patient.  One  attack  of 
Yellow  Fever  renders  the  person  imjmune  to  another  attack — that  is, 
they  cannot  have  it  twice. 

Prevention — The  best  course  in  Yellow  Fever  is  to  prevent  its  spread. 
Place  the  patient  in  a  screened  room  or  hospital.  It  is  not  necessary  to 
keep  him  or  her  away  from  others  with  the  disease  or  to  exclude  the  family, 
as  Yellow  Fever  is  not  contagious.  Only  be  sure  that  all  mosquitoes  are 
killed  and  kept  out  of  the  room  by  screened  doors  and  \\andows.  In  cases 
of  an  epidemic  the  local  Board  of  Health  will  do  well  to  call  upm  the 
State  and  Federal  authorities  to  aid  in  fighting  this  dreaded  disease. 
Every  town  or  city  in  tropical  or  subtropical  countries  should  do  every- 
thing possible  to  destroy  tbe  mosquito  and  its  breeding  places.  The 
following  are  the  rules  adopted  by  the  United  States  Anny  for  the  pro- 
tection of  troops  from  the  yellow  fever  mosquito: 

''1st.  The  universal  use  of  mosquito  bars  in  all  bari-acks  and  espe- 
cially in  all  hospitals,  and  also  in  field  service  when  practicable. 

"2d.  Tbe  destniction  of  the  larvae  or  young  mosquitoes,  com- 
monly known  as  Sviggletails,'  by  the  use  of  petroleum  on  the  water  where 
they  breed. 

"The  mosquito  does  not  fly  far  and  seeks  shelter  when  the  wind 
blo\vs :  so  it  is  usually  the  case  that  each  community  breeds  its  own  supply 
of  mosquitoes  in  wnier  barrels,  fii-e  buckets,  post  holes,  old  cans,  cesspools 
or  undrained  puddles. 


298  THE  EKUPTIVE  DISEASES. 

"An  application  of  one  ounce  of  kerosene  to  each  fifteen  square  feet 
of  water,  twice  a  month,  will  destroy  not  only  all  the  young  but  the  adult 
females  who  come  to  lay  their  eggs.  The  water  in  cisterns  or  tanks  is 
not  affected  for  drinking  or  washing  purjioses  by  this  ajiplication  if  only 
it  is  drawn  from  below  and  not  dipped  out. 

"For  pools  or  puddles  of  a  somewhat  permanent  character  draining 
or  filling  up  is  the  best  remedy." 

[Definition — ^An  acute  infectious  disease  characterized  by  yellowness 
of  the  skin  and  accompanied  in  the  severer  cases  by  black  vomit,  sup- 
pression of  the  urine,  with  hemorrhage  from  the  stomach,  nose  and  mouth. 
It  is  almost  peculiar  to  tropical  climates  and  not  apt  to  spread  in  tempera- 
tures below  72  degrees  Fahrenheit.  It  is  extremely  fatal.  It  is  not  con- 
tagious. It  can  only  be  acquired  by  bite  of  the  female  mosquito  known  aa 
Stegomyia  fasciata. 

Symptoms. — Yellow  fever  presents  three  well-defined  stages.  The 
first  is  characterized  by  intense  pain  in  the  head  and  back,  injected  eyes, 
rapid  pulse  -and  elevated  temperature.  This  stage  may  last  from  twenty- 
four  hours  to  six  days — according  to  the  severity  of  the  attack,  nausea 
and  vomiting  are  present  and  become  more  intense  on  the  second  or  third 
day.  The  bowels  are  "usually  constipated.  As  early  as  the  first  morning, 
according  to  Guiteras,  the  face  is  decidedly  flushed,  more  so  than  in  any 
other  infectious  disease  at  such  an  early  period.  The  second  stage  is 
characterized  by  the  following  symptoms : 

The  Pulse — One  of  the  diagnostic  signs  is  that  with  an  ascending 
temperature,  there  will  be  a  descending  pulse.  On  the  first  day  the  pulse 
is  rarely  more  than  100  or  110 ;  on  the  second  or  third  day  while  the 
temperature  keeps  up  the  pulse  begins  to  fall  and  may  become  slower  to 
the  extent  of  twenty  beats.  On  the  evening  of  the  third  day  there  may 
be  a  tem])erature  of  103  degrees  and  a  jjulse  of  75 ;  it  may,  during  defer- 
vescence stage,  go  down  as  low  as  30. 

The  Fever — On  the  morning  of  the  first  day  the  temperature  may 
vary  from  103  degrees  to  106  degrees ;  during  the  evening  of  the  first  day 
and  the  morning  of  the  second  day  the  temperature  keeps  about  the  same. 
There  is  a  slight  diurnal  variation  in  the  second  and  third  days. 

The  Calm  Stage — Third  stage,  the  remission  or  stage  of  calm,  as  it 
has  been  called,  is  succeeded  by  a  febrile  reaction,  or  secondary  fever 
which  lasts  one,  two  or  three  days,  and  in  favorable  cases  falls  by  a  short 
lysis.  On  the  other  hand,  in  fatal  cases  the  temperature  rises  rapidly, 
becomes  higher  than  in  the  initial  fever  and  death  follows  shortly.     The 


TELLOW  FEVER.  299 

second  stage  is  marked  by  depression  of  the  nervous  and  muscnlar  forces, 
and  of  the  general  and  capillary  circulations,  slow  and  intermittent  pulse, 
jaundice,  urinary  suppression,  passive  hemorrhages  from  the  bowels,  nose, 
gums,  uterus  and  nearly  all  the  organs  lined  with  mucous  membranes 
and,  in  cases  of  unusual  severity,  also  from  the  eyes,  ears  and  skin.  Black 
vomit,  delirium  and  coma  generally  terminate  in  death. 

In  more  severe  cases  the  symptoms  resemble  to  a  considerable  extent 
those  of  relapsing  fever,  and  it  is  impossible  to  foretell  from  any  of  these 
indications  how  serious  these  consequences  may  prove  to  be.  In  truth, 
these  sequels  constitute  the  most  distinctive  chai-acteristics  of  yellow  fever 
and  comprise  the  "black  vomit,"  so  well  known  and  dreaded  as  a  fatal 
symptom.  The  black  vomit  is  frequently  preceded  by  the  white  vomit, 
as  it  is  called,  which  is  a  clear  acid  liquid,  and  at  this  time  some  pain  is 
usually  felt  on  pressTire  over  the  pit  of  the  stomach.  The  occurrence  of 
this  black  vomit  is  well  known,  even  among  sailors  to  West  Indian  ports, 
as  a  fatal  sign  in  yellow  fever,  although  occasionally  a  patient  recovers 
after  this  gloomy  harbinger  of  death  has  manifested  itself.  The  yellow- 
jaundiced  hue  of  the  skin,  vsrhen  well  marked,  indicates  a  severe  form  of 
the  disease,  but  has  by  no  means  the  terribly  fatal  import  of  the  black 
vomit. 

1.  Prognosis. — There  are  epidemics  in  which  all  persons  attacked 
are  seriously  ill  or  die.  There  are  epidemics  of  medium  intensity  in 
which  the  jirogress  of  the  disease  is  limited  and  the  mortality  low.  Finally, 
there  are  mild  epidemics  in  which  nearly  all  the  patients  recover.  The 
virulence  of  the  epidemics  seems  to  depend  upon  the  month  in  which  it  is 
imported.  The  pathogenic  bacillus  increases  in  virulence  in  the  months 
of  May,  June  and  July.  On  the  other  hand,  the  epidemics  which  are 
imported  in  the  months  of  August,  September  and  October  are  very 
mild,  owing  to  the  attenuation  of  the  bacillus. 

2.  The  Individual  Attacked — Should  the  patient  prior  to  his  attack 
have  been  addicted  to  the  use  of  alcohol,  should  he  be  debilitated  from 
overwork,  sexual  excesses  or  bad  living,  and  lastly,  if  he  be  old,  the  prog- 
nosis is  against  his  recovery.  The  younger,  the  healthier  and  stronger  the 
patient  the  greater  are  his  chances  for  recovery.  When  the  fever  reaches 
its  maximum  at  the  onset  and  defervescence  is  continuously  noted  at  each 
visit,  the  disease  is  mild ;  even  when  the  fever  ranges  between  103  and 
104.5  degrees  Fahrenheit  during  the  first  thi-ee  days,  with  a  remission  of 
at  least  a  degree  in  the  morning  and  the  exacerbations  are  less  and  less 
pronounced  each  night,  the  patient  always  gets  well.     When  the  fever 


300  THE  ERUPTIVE  DISEASES. 

ranges  between  104  and  105  degrees  Fahrenheit,  still  ■with  remissions  of 
at  least  a  degree,  but  with  exacerbations  above  the  degree  of  fever  of  the 
previous  day,  the  disease  is  to  be  considered  grave.  The  cases  of  recovery 
are  more  numerous  than  the  fatal  ones  even  here.  But  when  the  fever 
reaches  105  degrees  Fahrenheit  or  above  within  the  first  twelve  hours 
the  disease  is  usually  fatal,  unless  heroic  treatment  immediately  produces 
a  defen'escence  of  two  or  three  degrees.  Copious  urine  is  always  a  good 
augury,  even  should  it  contain  five  or  ten  per  cent,  of  albumen. 

Scanty  TJrine  with  twenty  to  twenty-five  per  cent,  of  albumen  on  the 
second  day,  accompanying  a  fever  about  104  degrees,  indicates  great 
danger.  When  tlie  urine  froms  a  complete  coagulum  on  being  heated 
death  is  certain.  When  anuria  lasts  twelve  hours  death  is  absolutely 
certain. 

Intense  Jaundice  on  the  third  day,  urine  scanty  and  albuminous,  with 
black  vomit  occurring  at  the  same  time,  always  results  fatally. 

Black  Vomit  is  less  grave  in  children  and  in  yoimg  women  than  in 
adults,  particularly  those  over  forty  years  of  age;  the  latter  always  die. 

Profuse  Bleeding  of  the  gums  coming  before  or  at  the  same  time  as 
the  black  vomit  indicates  an  almost  desperate  state.  Should  it,  however, 
occur  on  the  fourth  day  and  the  gums  being  sound,  the  prognosis  is  less 
gloomy. 

Women  having  uterine  hemorrhage  on  the  fourth  and  fifth  days  with 
black  vomit  never  recover. 

Treatment — There  are  two  great  jirinciples  to  be  carried  out  in  the 
treatment  of  yellow  fever : 

1.  To  strengthen  and  sustain  the  organism  by  fortifying  the  nervous 
system,  by  arresting  congestion  and  by  increasing  the  blood  pressure  and 
diuresis. 

2.  To  consume,  destroy  and  eliminate  the  toxin. 

First  of  Above. — The  first  of  the  above  is  met  by  means  of  cold 
sponging  or  cold  batlis,  administered  not  in  a  routine  way,  but  by  taking 
the  virulence  of  the  disease  and  the  degree  of  the  fever  as  a  guide. 

Second  of  Above. — The  second  indication  is  met  by  putting  the  pa- 
tient in  a  well  aerated  room,  night  and  day,  and  making  him  drink  in 
order  to  cleanse  his  blood  and  to  dihite  the  toxin  and  eliminate  them  by 
way  of  the  urine,  two  to  four  quarts  of  Vichy  water  in  twenty-four  hours. 

It  is  during  the  first  three  days  of  the  disease  that  the  physician 
must  act. 

Absolute  Best.- — Put  the  patient  to  bed,  rest  is  essential  and  indis- 


BUBONIC   PLAGUE,  301 

pensable,  walking,  moving  or  the  least  muscular  effort  always  increases 
the  fever,  and  consequently  the  disease. 

Aeration  of  the  Room. — The  patient  must  bo  placed  in  the  largest 
and  best  ventilated  room  in  the  house.  Exposed  to  the  rising  sim  if  pos- 
sible. Keep  the  windows  open  night  and  day ;  do  not  let  patient  be  in  a 
draught,  but  let  the  outside  air  enter  and  circulate  freely. 

Cleanliness. — The  patient  must  be  kept  clean ;  should  he  be  soiled 
by  evacuation  of  the  bowels  or  vomit,  change  the  linen  at  once  and  plunge 
the  soiled  clothes  in  an  antiseptic  solution ;  cleanse  the  patient's  teeth  twice 
a  day  with  cooking  soda  and  warm  water.  Administer  morning  and  night 
an  enema  containing  a  pint  of  warm  water  and  a  tablespoonful  of  sul- 
phate of  magnesia. 

The  Urine  should  be  examined  each  day  to  see  how  the  kidneys  are 
acting. 

Treatment  of  the  Vomiting. — Let  the  patient  eat  small  pieces  of  ice, 
but  absohito  rest  for  the  stoniach  is  the  better  plan. 

Nourishment. — None  should  be  given  for  the  first  seventy-two  hours, 
after  that  milk  every  four  hours.  Starve  your  patient  whether  he  be 
child  or  adult,  unless  the  fever  be  below  102  degrees  Fahrenheit.  Vichy 
water  in  large  quantities  should  be  given  from  the  onset  of  the  disease. 

Medicinal  Treatment — At  the  onset  give  one  to  three  grains  of  calo- 
mel, depending  on  the  age  of  the  patient,  but  not  enough  to  purge.  In 
desperate  cases  enemas  of  strong  black  coffee  to  which  is  added  two 
tablespoonfuls  of  brandy  have  been  found  beneficial. 


BUBONIC  PLAGUE. 

Definition — An  acute  infectious  disease,  which  is  identical  with  the 
pestilence  of  India  and  the  black  death  of  Europe  in  former  ages,  and  is 
attended  with  buboes  or  boils  of  the  lymphatic  glands  of  the  groins,  as 
well  as  other  glands  and  occasionally  with  carbuncles.  It  is  very  easily 
communicated  by  human  intercourse  and  is  probably  the  most  fatal  of  all 
the  eruptive  fevers. 

Cause. — Tlie  specific  bacillus  which  causes  this  disease  was  discovered 
by  Kitasato,  and  occurs  in  the  blood  and  in  the  organs  of  the  body.  It 
obtains  entrance  through  the  digestive  an9  respiratory  tracts. 

History. — The  earliest  positive  accounts  date  from  the  second  cen- 
tury of  our  era.     From  the  great  plague  in  the  days  of  Justinian   (sixth 


302  THE  ERUPTIVE  DISEASES. 

century)  to  the  miifdle  of  the  seventeenth  centiirj  epidemics  of  varying 
severity  occurred  in  Eurojie.  Although  the  inhabitants  of  the  Uniled 
States  have  hitherto  been  spared  any  visitation  from  the  pLigue,  yet,  as 
the  shipments  of  rags  from  Italian  ports  with  marble,  for  which  they  are 
used  as  wrapping,  is  carried  on  quite  extensively,  germs  of  this  terrible 
malady  may  at  any  time  be  imported  and  planted  within  our  borders.  In 
the  last  great  outbreak  of  plague  in  Astrakhan,  a  province  of  southeastern 
Russia,  the  starting-point  of  the  whole  epidemic  was,  it  is  said,  traced 
to  a  shawl  brought  by  a  Cossack  returning  from  the  war  in  Afglianistan, 
as  part  of  his  booty,  and  presented  to  his  sweetheart.  The  girl  wore  the 
fatal  gift  for  a  few  days,  when  she  sickened  with  all  the  symptoms  of 
plague  and  died.  During  the  following  four  days  the  rest  of  her  family, 
six  in  number,  sickened  and  died.  From  these  poor  peojile  the  disease 
spread  rapidly,  and  proved  very  fatal,  devastating  nineteen  villages  in 
that  district.  Its  deadly  march  was  only  checked  by  a  double  cordon  of 
soldiers  being  placed  around  the  infected  towns,  and  absolute  non-inter- 
course, on  the  plan  of  the  shot-gun  quarantines  of  our  Southern  States, 
enforced. 

Symptoms — In  the  milder  cases,  patients  are  attacked  with  violent 
headache,  transient  shiverings,  alternating  with  intense  heat  of  skin, 
sometimes  terminating  in  death  from  prostration.  In  the  more  severe 
form  the  persons  affected  are  suddenly  seized  with  palpitation  of  the 
heart,  irregularity  of  the  pulse,  vomiting,  difficulty  of  breathing,  spitting 
of  blood,  and  syncope  or  fainting.  The  face  becomes  pale,  the  expression 
apathetic,  the  eyes  dull  and  the  pupils  dilated.  The  patients  lie  for  three 
or  four  hours  in  a  state  of  absolute  prostration  and  then  a  violent  accession 
of  fever  with  delirium  followed,  in  which  the  urine  is  suppressed  and  the 
bowels  constipated.  Dark  purplish  spots,  from  one-tenth  of  an  inch  to  one 
inch  in  diameter,  appear  over  the  body,  which  exhale  a  peculiar  odor 
somewhat  resembling  honey,  and  death  is  preceded  by  lethargy  and  col- 
lapse. The  corpses  become  putrid  in  two  or  three  hours  after  decease. 
Death  sometimes  occurs  in  twelve  hours  from  the  first  onset. 

The  fever  may  reach  10-i  degrees  or  106  degrees  Fahrenheit,  and  the 
tongue  becomes  brown.  The  inguinal  glands  are  most  often  affected,  then 
in  order,  the  axillary,  the  cervical  and  the  popliteal.  Carbuncles  also 
develop  in  different  parts  of  the  skin,  particularly  on  tlie  legs,  buttocks 
or  back. 

Treatment — Free  stimulation,  nutritious  food,  as  in  the  most  adyna- 
mic forms   of   typhus   and   typhoid   fever   together  with   cool   baths   to 


BUBONIC  PLAGTH.  303 

combat  the  fever,  are  the  measures  indicated.  Antiseptia  treatment  of  tke 
abscesses  should  be  practiced. 

Preventive  Measures — In  India,  from  1896  to  1907,  the  number  of 
cases  of  plague  was  1,400,000,  with  1,200,000  deaths.  Owing  to  the  filth 
and  fanaticism  of  the  people,  neither  curative  nor  preventive  agencies 
were  of  much  avail.  It  is  evident  that  the  greatest  care  is  now  demanded 
of  every  country  to  be  watchful  and  to  adopt  all  necessary  measures  to 
prevent  a  lodgment  of  the  plague.  Its  introduction  is  due  (1)  to  the 
arrival  in  a  community  of  jjersons  suffering  from  it,  or  who  are  in  the 
incubative  stage  of  the  disease;  and  (2)  through  the  instrumentality  of 
rats,  which  are  reagents  of  the  plague. 

Precautions  as  to  Persons — As  to  persons,  precautions  against  the 
plague  resolve  themselves  into  measures  of  quarantine  observance.  Every 
vessel,  its  crew  and  all  passengers  arriving  from  infected  ports  should 
undergo  most  critical  scrutiny.  Temperatures  should  be  taken  on  arrival, 
and  efforts  made  to  distinguish  between  the  mild,  or  amulant,  cases  and 
those  of  the  croupous,  or  pneumatic  type.  The  history  of  each  individual 
with  a  mild  case  should  be  carefully  looked  up.  Examination  should  be 
made  of  the  glandular  regions,  the  groins,  the  axillae,  the  neck,  and  if 
buboes  are  found  they  should  be  carefully  distinguished  from  those  due 
to  venereal  infection.  For  the  detection  of  cases  of  the  pneumatic  type, 
the  rcsi^iratory  organs  should  be  carefully  examined,  and  the  sputum 
subjected  to  microscopic  or  bacteriological  tests  to  discover,  if'  possible, 
the  plague  bacillus. 

Incubation — The  period  of  incubation  of  the  plague  for  quarantine 
purposes  should  be  regarded  as  seven  days,  and  individuals  from  ports  or 
places  where  plague  is  knowm  to  prevail  should  be  detained  for  a  period 
to  complete  seven  days  from  the  last  exposure  to  infection,  and  should  be 
subjected  to  critical  insjicction  twice  a  day. 

Quarantine  Against  Rats — To  prevent  the  introduction  of  the  disease 
through  the  agency  of  rats  on  vessels  from  infected  jjorts,  every  part  of  the 
vessel  should  be  disinfected  by  sulphur  fumes  for  the  destruction  of  thd 
rodents,  and  their  passage  from  vessel  to  shore  should  be  prevented.  The 
vessel  should  not  be  unloaded  at  a  dock,  but  in  mid-stream,  by  means  of 
lighters.  All  rats  found  dead  by  the  fumigation  should  be  subjected  to 
bacteriological  examination,  their  bodies  gathered  and  burned,  and  the 
places  where  they  were  found  disinfected  with  a  germicidal  solution,  or 
with  boiling  water.  Fleas  from  the  rats  should  be  similarly  guarded 
against,  for  they  usually  leave  a  dead  rat,  and  thus  help  to  spread  the 


304  THE   ERUPTIVE   DISEASES. 

plague  germs.  All  masters  of  vessels,  agents  and  consular  oiScers  would 
do  well  to  subject  their  vessels  to  disinfection  for  the  destruction  of  rata 
at  intervals  of,  say,  three  months. 

Procedure  in  Cities — When  the  plague  has  made  its  appearance  in  a 
city,  tlie  authorities  should  promiJtly  pass  anti-plague  ordinances  regu- 
lating garbage  disposal,  and  placing  all  unsanitary  buildings  and  places 
in  sanitary  condition.  All  garbage  and  kitchen  waste  should  bo  collected 
and  removed  in  covered,  rat-proof  cans;  rat  runs  and  burrows  should  be 
destroyed  or  filled  in  with  broken  glass ;  house  drains  should  bo  repaired ; 
all  nuisances  should  be  abated;  garbage  should  never  be  dumped  in  places 
accessible  to  rats,  but  should  be  burned ;  an  active  campaign  against  rats 
should  be  inaugurated,  either  by  traps  or  by  poisons,  such  as  arsenic, 
phosphorus  paste  and  carbonate  of  baryta.  Eat  poisons  should  be  fre- 
quently changed,  as  well  as  the  manner  of  displaying  them.  After  the 
appearance  of  the  plague  in  San  Francisco  in  September,  1907,  the 
campaign  against  rats  resulted,  in  a  few  months,  in  the  capture  of 
278,000  rats,  and  the  destruction  by  poison  of  500,000.  Perhaps  no  other 
agency  was  so  potential  in  ridding  the  city  of  the  plague. 

Plague  in  the  House — Tlie  house  or  dwelling  in  which  plague  appears 
should  be  vacated.  The  house  should  bo  disinfected  and  fumigated, 
poison  spread  and  trapping  instituted  to  rid  the  premises  of  rats.  Cellars 
and  basements  should  be  made  rat-proof  to  prevent  their  return.  Patients 
suffering  with  plague  should  be  removed  to  a  rat-proof  hospital  for  treat- 
ment, and  those  who  have  been  in  contact  with  the  dwelling  should  be 
isolated  in  some  sanitary  place  for  a  time  suiEcient  to  cover  the  period  of 
incubation   of  tlie   disease. 

Serum  Treatment — ^Yhile,  as  has  been  seen,  the  TJ.  S.  Bureau  of 
Health  relies  chiefly  on  preventive  measures  for  the  extermination  of 
bubonic  plague,  it  by  no  means  ignores  the  agencies  which  modem  science 
places  at  its  disposal  for  immunization  from  tlio  disease  or  for  dislodging 
it  from  the  system.  It  has,  therefore,  experimented  much  with  the 
prophylactic  (preventive)  fluid  of  Dr.  Ilaffkine,  by  inoculating  the  system 
"with  it.  In  some  cases  it  gave  gratifying  results,  and  in  others  proved 
disappointing.  So  also  the  antipest  serum  of  Dr.  Yersin  has  been  tried 
and  found  to  contain  prophylactic  qualities  of  a  decided  character,  but 
the  duration  of  the  immunity  offered  is  very  uncertain;  however,  in  the 
treatment  of  actual  cases  of  plague  this  antipest  serum  has  been  found 
decidedly  beneficial  if  used  sufficiently  early  in  the  disease  and  in  suffi- 


BUBONIC    rLAQDE.  305 

ciently  large  closes.  This  serum  is  produced  by  the  Pasteur  Insfitulc  at 
Paris,  France,  and  at  the  Bacteriological  Institute  at  Ljou. 

Outgoing^  Quarantine — If  the  city  iu  whicli  the  jilague  has  made  its 
appearance  is  a  seaport,  all  outgoing  vessels  should  be  subjected  to  careful 
scrutiny,  and  should  be  thoroughly  fumigated  with  sulphur  before  taking 
on  cargo  to  insure  the  destruction  of  rats.  Wharves  should  bo  rendered 
rat-proof;  gangways  should  bo  fended  and  guarded  day  and  night,  and  all 
articles  of  cargo  attractive  to  rats  should  be  kept  in  rat-proof  enclosures. 
Rags  intended  for  export  from  a  plague-infested  city  should  l^e  thoroughly 
sterilized,  or  else  destroyed  entirely,  for  it  is  quite  possible  that  they  may 
contain  the  dressings  used  in  the  treatment  of  jslague  cases.  They  may 
also  contain  the  dejecta  of  plague-infected  rats. 

Personal  Protection  Against  Plague. — The  following  statement  is  made 
by  Charles  S.  Braddock,  Jr.,  M.  D.,  of  Iladdoufield,  K  j_^  ]^fe  chief 
medical  inspector  of  the  lioyal  Siamese  Government,  in  his  "Notes  on 
Bubonic  Plague  as  Seen  in  Siam :" 

"Personally  in  attending  (plague)  patients  I  always  used  plenty  of 
coal  oil  on  my  shoes  and  stockings  and  on  my  leggings,  as  it  has  been  shown 
that  this  kept  the  fleas  away,  a  fact  whicli  was  practically  demonstrated 
in  Bombay  and  Calcutta,  wdiero  tlie  coolie  cmjiloyees  of  the  oil  companies 
Avere  found  not  to  contract  the  disease  which  was  raging  all  around  them. 
The  investigators  in  India  found  that  on  the  death  of  a  rat  the  infected 
fleas  promptly  left  the  dead  rat,  and  if  a  non-infected  rat  was  placed  near 
them  promptly  attached  themselves  to  him,  and  in  a  few  days  he  was 
infected  and  died  of  plague.  In  the  town  of  Petchaburi  I  traced  the 
great  and  excessive  death  rate  among  the  children  to  the  fact  that  after 
the  rats  died  the  infected  fleas  took  up  their  habitat  on  the  pariah  dogs, 
and,  these  being  petted  and  fed  by  the  children,  the  children  suffei-ed 
proportionately.  As  the  peoj)le  are  Buddhist  in  religion,  and  will  not 
destroy  life,  my  application  to  have  the  dogs  killed  was  not  granted.  One 
of  the  most  effective  measures  to  stop  the  disease  after  all  disinfection  and 
sanitation  was  accomplished  was  to  wash  all  floors  and  furniture  with  crude 
coal  oil,  and  sprinkle  it  with  a  watering  pot  in  large  quantities  imdcr  the 
houses  and  over  the  ground  in  the  vicinity." 


20 


306  IHE  EEUPTIVE   DISEASED 

SLEEPING  SICKNESS. 
{Hwman  Trypanosomiasis.') 

Sleeping  sickness  is  a  disease  affecting  human  beings,  ■wlilch  is  caused 
by  the  parasite — Trypanosoma  Gambiense,  getting  into  the  blood,  due  to 
the  bite  of  the  Tetse  Fly.     It  is  usually  fatal. 

Sleeping  sickness  has  occurred  for  the  last  hi:ndred  years  on  the 
VFest  coast  of  Africa,  and  the  disease  includes  the  country  between  the 
Gambia  and  Congo  rivers. 

In  1896  to  1001  this  disease  occiirred  in  Uganda,  Africa.  It  -was 
evidently  brought  there  by  the  natives  who  came  from  the  Congo  State 
where  the  disease  prevailed.  It  was  not  recognized  until  1901,  when  the 
cases  became  numerous. 

Kace — This  disease  can  develop  in  any  race  of  people  if  exposed  to; 
the  bite  of  the  Tetse  Fly. 

Occupation. — Any  work  which  leads  a  native  or  foreigner  to  spend 
much  time  on  the  shores  of  the  rivers  and  lakes  within  the  sleeping  sickness 
territory,  exposes  himself  to  the  disease.  Native  negroes  contract  sleeping 
sickness  more  than  the  whites,  due  to  the  fishermen,  canoemen  and  other 
inhabitants  being  half  naked  and  thus  constantly  bitten  by  the  Tetse  flies, 
30  to  80  per  cent,  of  them  having  the  parasite  in  their  blood. 

Any  person  of  any  age  or  condition  of  health  will  develop  sleeping 
sickness  if  bitten  by  a  fly  which  has  previously  sucked  the  Trypanosoma 
ifrom  the  blood  of  a  sufferer  from  the  disease. 

Cause. — The  sleeping  sickness  is  due  to  a  minute,  wriggling,  worm- 
like parasite,  called  the  Trypanosoma  Gambiense,  named  by  Doctor  Diitton. 
of  England,  in  1901,  who  was  sent  to  investigate  this  disease  which  was 
causing  the  slow  death  of  thousands  of  negroes  in  Africa.  This  parasite 
is  only  seen  when  blood  is  drawn  from  a  vein  or  lymphatic  gland  and 
examined  under  the  microscope.  It  is  very  difficult  to  discover  and  often 
requires  several  examinations  of  the  blood  before  it  can  be  seen.  When 
the  Trypanosoma  flrst  is  injected  beneath  the  skin  by  the  bite  of  the  fly 
it  passes  to  the  lymphatic  system,  where  it  is  found  in  great  numbers, 
causing  a  swelling  of  the  lymph  glands,  then  passing  in  small  numbers 
into  the  general  circulation. 

These  parasites  only  reproduce  themselves  within  the  human  body. 
They  do  not  pass  out  in  the  urine  or  stools,  but  only  when  the  lymphatic, 
duct  blood  fluids  are  withdra^vn. 


SLEEPING  SICKNESS.  307 

Sleeping  sickness  is  not  contagious,  but  is  considered  infectious. 
A  delicate  parasite  which  is  incapable  of  living  outside  of  the  human 
body  cannot  be  conveyed  by  drinking  water,  food,  dust,  etc.,  as  other 
germs  are. 

Entry  of  Germ  into  the  Human  Body. — The  Trypanosoma  is  con- 
veyed from  the  sick  to  the  well  by  the  Tetse  Fly  (Glossina  Palpalis),  and 
it  is  the  only  species  of  fly  known  to  harbor  the  parasite.  Wherever 
sleeping  sickness  prevails,  the  Tetse  Fly  is  correspondingly  abundant  upon 
the  shores  of  the  rivers,  lakes,  etc.  This  has  been  proven  by  taking  flies 
which  were  caught  in  the  sleei^iug  sickness  zones  and  alluring  them  to 
bite  monkeys,  the  latter  developing  the  symptoms  of  the  sleei^iug  sickness. 
The  Tetse  Fly  cannot  transmit  the  disease  after  three  days  have  elapsed 
since  biting  a  sufferer.  The  disease  usually  develops  in  a  new  case  from 
eight  to  forty-eight  hours  after  the  fly  has  bitten  a  previous  sufferer. 

The  Tetse  Fly  is  only  found  along  the  shores  of  rivers  and  lakes, 
where  there  is  forest,  which  consists  of  high  trees,  thick  jungles  and 
dense  undergrowth.  They  are  never  seen  on  open  sandy  beaches  backed 
by  grass  plains,  nor  in  the  grass  of  the  grassy  plains  even  though  long 
and  tangled. 

Symptoms,  First  Stage — After  a  person  is  bitten  by  a  Tetse  Fly,  the 
trypanosoina  is  injected  beneath  the  skin  and  then  reaches  the  lymphatic 
and  blood  fluids  of  the  body,  wherein  it  multiplies.  As  far  as  is  known 
they  do  not  appear  in  the  general  circulation  until  twenty  days  have 
elapsed.  The  course  of  this  stage  of  sleeping  sickness  is  very  slow  and 
takes  months  and  possibly  years  for  the  symptoms  to  develop.  The 
average  is  between  three  months  to  three  years  or  more.  During  this 
period  the  sufferer  is  attending  to  his  ordinary  work  and  feels  well,  but 
there  is  an  enlargement  of  the  glands  of  the  back  of  the  groins  and  armpits, 
which  can  be  observed  and  felt  as  swellings  bulging  the  skin  in  these  parts 
of  the  body.  If  fluid  is  drawn  from  these  swelling  glands,  after  many 
careful  searches  the  trypanosoma  can  be  seen  by  the  microscope.  These 
glandular  enlargements,  with,  of  course,  the  finding  of  the  parasites,  and 
the  history  of  a  person  having  been  in  a  sleeping  sickness  area,  and  bitten 
by  the  Tetse  Fly  are  symptoms  and  facts  which  will  prove  that  the 
patient  is  suffering  from  this  disease. 

Second  Stage — During  this  period  the  patient  is  apparently  lazy  and 
inclined  to  lay  around  and  sleep  during  the  day.  He  becomes  more 
sleepy  as  the  disease  advances,  the  expression  of  the  face  is  sad  and  apa- 
thetic, he  is  mentally  dull,  the  eyes  are  dull  and  heavy,  the  eyelids  droop. 


308  THE  EEUPTIVE  DISEASES. 

The  body  is  'well  nourished  uutil  late  in  the  disease,  if  the  patient  is  well 
fed.  Headache  is  present,  or  there  is  complaint  of  dull  pains  in  other 
parts  of  the  body.  The  pulse  is  rapid  and  weak.  The  lymphatic  glands 
are  seen  and  on  feeling,  are  about  the  size  of  a  pea  to  that  of  a  bean. 
There  is  never  any  eruption  (rash)  upon  the  skin.  The  patient  walks  with 
a  weak  gait,  uncertain  and  shufSing.  The  hand  grip  is  lost  and  the 
hands  tremble  when  held  out  at  right  angles  to  the  body.  The  tongue 
trembles  when  extended.  The  voice  is  mumbling,  weak  and  monotonous. 
The  fever  during  this  time  is  from  101  to  102  degrees  Fraheuheit  in 
the  evening.  These  symptoms  generally  grow  worse  uutil  after  weeks 
or  months  the  patient  is  unable  to  talk,  walk,  or  feed  himself.  He  is 
confined  to  bed,  sleeps  continually,  is  usually  neglected  and  not  fed  by 
the  ignorant  relatives  and  friends,  and  becomes  very  thin.  During  the 
last  two  or  three  weeks  the  urine  and  stools  pass  without  his  knowledge 
and  the  temperature  drops  to  92  degrees  Fahrenheit  and  he  dies  in  a 
state  of  coma  (stupor). 

Treatment. — There  is  no  known  remedy  whicb  will  kill  the  trypa- 
nosoma  in  the  human  body,  nor  any  drug  which  will  aid  the  patient  in 
fighting  the  attack.  It  is  a  fatal  disease  and  so  far  as  is  known  every 
sufferer  from  sleeping  sickness  sooner  or  later  dies  from  its  effects.  Iron, 
quinine  and  arsenic  have  been  used  as  tonics,  but  with  no  resiilts  as  to 
cure,  simply  prolonging  life.  Every  known  drug  has  been  tried  without 
success. 

Prevention — Sleeping  sickness  is  difficult  to  prevent  owing  to  its  oc- 
currence in  a  country  which  is  inhabited  by  ignorant  and  superstitious 
savages,  infested  with  the  Tetse  Fly,  which  alone  spreads  the  disease.  The 
fly  cannot  easily  be  destroyed  owing  to  the  dense  jungles  and  forests  which 
spread  out  from  the  shores  of  the  lakes  and  rivers  in  the  sleeping  sickness 
areas.  These  cannot  be  burnt  owing  to  their  green  and  damp  condition.  If 
the  natives  were  intelligent  they  might  be  urged  to  move  from  the  infested 
region,  but  only  the  intelligent  ones  do  this,  the  remainder  would  rather 
die  than  leave  their  shambles  and  their  tribes.  If  removal  does  take  place 
care  must  be  taken  to  see  that  no  species  of  Tetse  Fly  is  present  which, 
might  convey  the  disease  to  the  new  location. 

Among  intelligent  people  the  disease  is  preventable  by  not  living 
in  a  sleeping  sickness  area,  or  if  compelled  to  live  there  by  wearing  cloth- 
ing which  covers  the  body  completely  and  mosquito  helmets  for  the  face, 
and  the  screening  of  all  doors  and  windows  of  houses,  etc.  Kill  all  flies 
seen  indoors  and  remove  all  vegetation  in  the  vicinity  of  the  dwelling 


HOOKWORM  DISEASE.  309 

and  cultivate  the  ground  if  i^ossiblc.     Do  not  expose  joiirself  in  any  way 
to  the  bite  of  the  Tetse  Fly. 

HOOKWORM  DISEASE. 

The  spread  of  hookworm  disease  is  duo  cliiefly  to  the  lack  of  sani- 
tary privies  in  the  Southern  homes  and  schools  of  the  people  in  the  vil- 
lages, towns,  etc.  The  depositing  of  bowel  movements  upon  the  soil  and 
a  poor  sewage  disposal  is  a  means  by  which  the  parasite  reaches  the  water 
supply.  In  some  of  the  Southern  colleges  thirty  per  cent,  of  the  students 
and  as  high  as  ninety-five  per  cent,  of  the  pupils  in  the  common  schools 
showed  the  hookwonu  in  the  discharges  from  the  bowels  and  the  bladder,  as 
proven  when  they  were  examined  by  the  microscope.  Those  who  had  the 
disease  were  backward  students  as  compai'ed  with  the  uninfected  pupils, 
thus  showing  how  the  disease  lowered  their  capacity  for  work  and  study. 

If  one  child  has  a  case  of  hookworm  disease  in  the  home  or  school, 
and  the  latter  have  unsanitary  jirivics,  every  child  in  them  is  liable  and 
usually  does  contract  this  dangerous,  contagious  disease. 

Cause  of  Hookworm  Disease. — It  is  caused  by  a  small,  round  worm 
about  half  an  inch  long  and  as  thick  as  a  pin.  The  forms  occurring  in 
man  do  not  develop  to  maturity  in  the  lower  animals.  The  special  variety 
discovered  in  this  country  has  been  named  the  "Necator  Americanus"  or 
"American  Murderer"  by  Dr.  Stiles.  Its  color  varies  from  a  dead  white 
to  a  dirty  gray,  sometimes  red  from  the  continued  blood  which  it  ha.? 
■iiucked  from  its  victim. 

How  the  Parasite  Gets  Into  the  Body. — The  worms  do  not  multiply  in 
the  body,  but  the  adult  females  deposit  great  numbers  of  eggs  in  the  small 
bowel,  from  a  few  hiindred  to  throe  or  four  thousand  every  day,  which  are 
carried  out  with  the  normal  bowel  movement.  The  eggs  hatch  out  the 
young  worms  called  larva?  In  tlic  course  of  twenty-four  hours.  Within  a 
week  the  tiny  organism  has  shed  its  skin  twice,  like  a  snake  docs.  It  lives 
In  this  cast-off  skin,  but  takes  no  food  after  the  first  few  days  following  its 
escape  from  the  eggs.  After  shedding  its  skin,  the  young  worm  is  capable 
of  entering  the  human  body  of  another  person  when  passed  out  in  the 
bowel  movement  of  the  person  In  which  It  is  developed.  It  may  enter  the 
human  body  in  one  of  three  ways.  First,  it  may  be  swallowed  with  con- 
taminated food,  milk  or  water.  Secondly,  it  gets  Into  the  body  by  boring 
through  the  skin.  Third,  the  eggs,  larvae  or  young  worms  may  be  carried 
on  the  legs  of  flies. 


310 


THE  EEDPTIVE  DISEASES. 


In  boring  tlirougli  tke  skin  the  young  worms  produce  tlie  condition 
kno^Ti  as  "dew  poison"  or  "ground  itch"  or  "too  itch,"  which  is  usually 
the  first  symptom  of  hookworm  disease.  The  "dew  poison"  occurs  mostly 
about  the  feet  and  ankles,  but  in  miners  or  farmers  who  work  in  infected 
or  polluted  ground,  and  sometimes  in  children,  the  "dew  poison"  appears 
in  the  hands  and  arms.  After  boring  through  the  skin,  the  worm  enters 
the  blood  stream  and  passes  through  the  heart  to  the  limgs,  makes  its  way 
up  to  the  windpipe  or  is  coughed  up  and  swallowed,  and  after  its  passage 
down  the  gullet  to  the  stomach  fiually  enters  the  small  bowel.     Ilaving 


HOOKWORMS.— A,   female;  B,  male. 


reached  the  bowel  where  it  elects  to  remain,  the  tiny  worm  sheds  its  skin 
twice  more,  becomes  fully  developed  and  mates.  The  worms  are  provided 
with  strong  jaws  and  a  hollow  tooth  somewhat  like  a  snake.  The  worm 
hooks  itself  to  the  wall  of  the  bowel  by  its  strong  jaws  and  sucks  the  blood 
of  the  child  or  adult  in  which  it  lives.  Thus  it  wounds  the  wall  of  the 
bowel,  sucks  the  red  blood  and  weakens  the  patient.  In  addition  the  worm 
mixes  the  blood,  after  digesting  it  with  its  own  poisonous  bowel  matter 
and  injects  or  squirts  it  through  this  hollow  tootk  into  tke  body  of  tho 


EOOKWOEM  DISEASE.  311 

patient.  Thus  the  hookworm  is  first — a  blood  destroyer;  and  second — a 
blood  poisoner. 

Symptoms. — If  a  child  is  infected  with  the  parasite  before  puberty 
(adultage),  the  physical  and  mental  condition  is  retarded.  A  boy  or  girl 
sixteen  may  j^resent  the  body  and  mind  of  one  of  eight  or  ten  years  of  age, 
and  yoimg  men  and  women  of  twenty  may  appear  to  be  not  more  than 
twelve  or  fifteen.  The  skin  is  pale,  perspiration  or  sweat  absent,  cuts  or 
bruises  heal  slowly.  In  the  early  stages  of  the  disease  "ground  itch," 
"dew  itch"  or  "toe  itch"  is  often  found  iipon  the  feet,  ankles  or  hands. 

The  hair  may  be  normally  developed  upon  the  head,  but  on  other 
parts  of  the  body  where  it  ought  to  be  it  is  generally  absent  or  scarce. 
The  face,  feet,  ankles,  and  in  extreme  cases  the  entire  body,  may  be  swol- 
len. This  swelling  disappears  rapidly  after  treatment.  Body  weight  is 
reduced.  The  chest  is  thin,  ribs  prominent,  the  shoulder-blades  stand  out 
upon  the  back  and  the  patient  appears  "round-shouldered."  The  expres- 
sion of  the  patient  is  anxious  or  very  stupid.  The  appetite  may  be  light  or 
it  may  be  ravenous,  the  child  being  unable  to  obtain  enough  food  at  an 
ordinary  meal  to  satisfy  its  appetite.  The  patients  often  develop  a  desire 
for  abnormal  articles  of  food  and  this  is  why  sufferers  of  hookworm  dis- 
ease are  called  "dirt  eaters :"  They  crave  and  eat  lemons,  pickles,  salt, 
pepper,  sour  milk,  chalk,  clay,  ashes,  tobacco,  mortar,  plaster,  sand,  gravel, 
sticks,  decayed  wood,  paper  and  cloth.  ISTausea  and  vomiting  are  frequent 
and  there  is  tendency  to  heartburn  and  pain  over  the  pit  of  the  stomach. 

The  blood  is  impoverished,  the  patient  suffering  from  thin  blood  or 
anasmia  as  a  result  of  the  red  cells  of  the  blood  being  destroyed  and  the 
blood  poisoned  by  the  worms  which  suck  it  out  and  at  the  same  time  in- 
ject into  it  the  poison  from  their  bowel  movements. 

The  only  sure  way  of  diagnosing  hookworm  disease  is  to  examine  the 
bowel  movements  of  the  jiatient  under  the  microscope  and  find  the  eggs, 
or  to  see  the  tiny  worms,  the  size  of  an  ordinary  pin  with  the  naked  eye, 
which  appear  before  or  after  treatment  in  the  stools. 

Hookworm  disease  is  termed  the  "lazy  disease."  This  is  due  to  the 
sufferers'  muscles  being  very  soft  and  weak.  The  shirking  of  work  and 
study  is  not  due  to  laziness,  but  is  nothing  more  or  less  than  weakness  or 
weariness  because  the  hookworm  is  sucking  their  blood.  They  must  be  con- 
sidered ill  and  treated  as  such. 

Treatment. — In  curing  hookworm  disease,  we  do  not  treat  the  pa- 
tient, biit  the  worms.  The  remedies  used  either  kill  or  cause  the  worm  to 
loosen  its  hold  on  the  wall  of  the  small  bowel.     The  treatment  must  always 


312  TUE  ERUPTIVE  DISEASES. 

be  given  under  the  care  of  a  physician.  It  is  simple  and  nsnally  very 
effective  if  directions  are  properly  followed.  It  can  be  given  to  those  who 
cannot  afford  to  stay  away  from  business  or  work  by  having  them  take 
the  treatment  on  Saturday  evening  or  Sunday  morning.  The  best  treat- 
ment is  to  give  the  drug  thjnnol  in  capsule  form. 

The  bowels  must  be  thoroughly  emptied  lief  ore  the  thymol  is  taken, 
so  that  all  mucous  and  undigested  food  which  surrounds  the  worm  is  re- 
moved, thus  giving  the  thymol  an  opportunity  to  come  in  direct  contact 
■with  the  hookworm  to  properly  affect  a  cure. 

Directions  to  Patient — At  bedtime  for  two  nights  before  taking  the 
capsules,  take  an  ordinary  dose  of  epsom  salts  and  during  the  intervening 
day  between  the  nightly  doses  of  salts,  eat  only  liquid  foods,  such  as  milk 
and  soups.  On  the  second  morning  after  taking  the  first  dose  of  salts,  do 
not  get  up,  and  eat  nothing  at  all,  and  at  6  A.  M.  take  one-half  of  all  the 
capsules  of  thymol  and  at  8  A.  ]\r.  the  remaining  half.  The  number  of 
capsules  to  be  taken  and  tlie  amount  of  each  one  depends  upon  the  age 
(uot  apparent  age)  of  the  patient.  This  nmst  be  judged  by  the  physician 
in  attendance.  At  ten  o'clock  the  same  day  take  a  dose  of  epsom  salts,  but 
do  not  take  oil,  fats  or  alcohol  while  taking  the  capsules,  as  these  sub- 
stances render  the  thymol  absorbable  by  the  digestive  tract  and  poisonous 
symptoms  occur.  After  the  bowels  have  moved  thoroughly  following  the 
ten  o'clock  dose  of  salts,  the  patient  may  eat  an  ordinary  meal,  and  it  will 
not  he  necessary  to  stay  in  bed.  This  treatment  is  recommended  by  Dr. 
Lock,  Inspector  of  tlie  Slate  Board  of  Health  of  Kentucky. 
The  Size  of  the  Total  Dose  of  Thymol. — 

Under  5  years  old   Yl  grains. 

Fi'om  5  to  9  years  old 15      grains. 

From  10  to  1  i  years  old 30     grains. 

From  15  to  19  years  old 40     grains. 

From  20  to  59  years  old CO     grains. 

Above  CO  years  old 30  to  45     grains. 

(Recommended  by  Dr.  Stiles.) 
It  lias  been  proven  that  after  one  treatment  of  thymol,  as  recom- 
mended by  Dr.  Lock  and  Dr.  Stiles,  ninety  per  cent,  of  the  eases  are 
ciired.  The  bowel  movements  must  be  examined  under  the  microscope 
two  weeks  after  each  treatment  for  the  purpose  of  finding  the  pin-sized 
Worms.  If  present,  the  thymol  treatment  must  be  repeated  until  all 
worms  are  absent  from  the  bowel  movements. 

The  anffimia  and  debility  of  all  sufferers  from  the  hookworm  disease 


HOOKWORM  DISEASE.  313 

will  soon  disappear  when  the  worms  are  destroyed  and  the  food  the  patient 
takes  is  absorbed  and  used  to  make  blood  by  the  system,  instead  of  being 
destroyed  and  poisoned  by  the  hookworm.  However,  iron  tonics  and 
nourishing  food  must  be  given  to  build  up  the  blood  and  aid  recovery. 

Prevention  of  Hookworm  Disease — Board  of  Health,  state,  coimty  and 
city,  in  the  Southern  States  are  spending  thousands  of  dollars  to  wipe 
out  the  hookworm.  It  has  been  discovered  that  the  worm  develops  as  a 
result  of  "soil  pollution."  Not  only  can  it  be  prevented,  but  at  the  same 
time  the  methods  used  are  preventive  of  typhoid  fever  and  other  germ  dis- 
eases, whose  jioisonous  elements  are  carried  in  the  bowels  and  urine  from 
the  infected  person  to  the  soil  and  water. 

Hookworm  disease  is  spread  as  a  result  of  the  carelessness  of  persons 
who  dispose  of  their  bowel  matter  upon  the  soil  and  by  the  use  of  unsani- 
tary privies  and  toilets  which  drain  upon  the  soil  or  a  water  supply. 

Shade  and  moisture  are  necessary  for  tlie  eggs  and  larvse  of  the  hook- 
worm to  hatch  and  develop.  Therefore,  those  who  are  infected  with 
hookworm  disease,  and  use  the  shaded  spots  where  no  privies  are,  to  pollute 
the  soil,  are  dejiositing  and  spreading  their  disease  by  their  carelessness; 
as  shady  spots  are  usually  moist  and  make  the  best  place  for  the  hook- 
worm to  develop. 

In  some  States  even  of  this  country  many  homes  in  villages  outside 
of  the  towns  and  cities  which  have  a  sewage  system  and  schoolhouses,  etc., 
have  no  privies.  (Think  of  it  in  the  twentieth  century  in  America.) 
Only  the  wealthier  families  have  an  occasional  toilet  on  the  premises,  and 
these  are  absolutely  rmsanitary  and  are  built  apparently  to  only  shield 
the  user.  Is  it  any  wonder  that  hookworm  disease,  typhoid  fever,  cholera 
infantum  and  dysentery  thrive  amid  such  surroundings  ? 

Hookworm  disease  can  be  prevented  from  spreading  by  first  curing 
the  present  sufferers  Avith  the  thymol  treatment,  the  building  of  sewage 
systems  in  the  larger  tovms  and  villages  with  sanitary  toilets,  the  build- 
ing of  properly  constructed  fly-proof  privies  on  farms,  in  schoolhouses, 
etc.,  the  removal  of  all  privies  from  a  location  where  the  waste  matter  can 
drain  on  to  the  soil  which  can  be  washed  by  rain  or  melting  snow  into  a 
spring,  creek,  river  or  any  other  water  supply  of  a  house,  camp,  farm, 
dairy,  etc. 

Children  or  adults  in  a  region  where  hookworm  disease  is  prevalent 
must  wear  shoes  to  protect  their  feet  and  ankles  from  the  larvaj  upon  the 
skin,  as  they  will  bore  through  and  In  this  way  get  into  the  system.  Boil 
all  water  and  milk  and  cook  vegetables. 


314  THE  EEUPTIVE  DISEASES. 

In  the  Southern  States  particularly,  and  others  also,  any  child  or 
adult  who  is  apparently  "lazy"  and  always  tired  with  a  puify  abdomen, 
tremendous  appetite,  swollen  eyes,  and  loss  of  weight  with  ansemia,  must  be 
taken  to  a  physician  or  public  dispensary  to  ascertain  whether  or  not  he  is 
suffering  from  the  hookworm  disease,  and  if  a  sufferer,  receive  treatment 
at  once.  Kill  all  flies  about,  screen  doors  and  windows  and  construct  a 
sanitary  privy. 

PELLAGRA. 

Pellagra  is  a  disease  the  cause  of  which  is  not  definitely  known.  So 
far  scientific  investigation  has  not  disclosed  any  germ  as  the  cause, 
though  some  physicians  believe  it  is  an  infectious  disease  and  can  be 
caught  from  a  new  case  appearing  in  a  community  for  the  first  time.  It 
has  been  proven  though  that  it  is  the  result  of  a  poison  which  exists  in 
spoiled  maize,  Indian  corn  or  corn  products.  This  theory  was  first  ex- 
plained by  Ballardini,  an  Italian  physician,  in  ISii,  his  theory  being  that 
the  maize  underwent  a  change  by  reason  of  the  growth  of  a  fungi  on  the 
grain,  which  acted  as  a  poison  to  the  system,  and  could  be  recognized  in 
the  grain  as  a  greenish  color.  Another  theory  put  forth  by  Dr.  Scaulon,  of 
the  London  School  of  Tropical  Medicine,  is  that  the  "black-fly"  or  "sand- 
fly" (simuUum  repatans)  causes  it.  Still  another  theory  is  that  it  is  due 
to  the  stable-fly  (Stomonys  calcitrans)  ;  the  mosquito  is  also  considered 
as  a  carrier  of  pellagra.  Others  claim  that  no  matter  what  the  definite 
cause  is,  it  is  a  disease  which  is  being  imported  into  this  country  by  the 
hordes  of  immigrants  from  Italy. 

Whatever  its  cause,  pellagra  is  a  serioiis  disease  and  has  been  a  na- 
tional scourge  in  Italy  and  other  European  countries  for  more  than  a  hun- 
dred years.  An  epidemic  occurred  in  Italy  in  1907  during  which  100,000 
cases  occurred  and  at  least  50,000  cases  in  Eoumania.  Thus  it  can  be  seen 
how  prevalent  the  disease  may  become  during  an  epidemic  and  cause  great 
mortality  as  well  as  loss  of  health  and  money  to  citizens  and  the  State. 
Several  cases  have  occurred  in  women  who  have  washed  the  clothes  of 
patients  suffering  from  this  disease,  due  to  a  poison  being  thrown  off 
from  the  glands  of  the  armpits  which  has  been  collected  upon  the  clothing 
and  may  have  caused  the  disease  in  the  laundresses,  showing  that  the 
disease  is  apparently  infectious. 

People  who  eat  spoiled  maize  or  Indian  com  have  developed  pellagra 
and  from  our  present  knowledge  of  the  disease  it  would  seem  that  this 
is  the  main  cause  of  tke  symptoms. 


PEI.I.AGEA.  315 

The  early  symptoms  of  pellagra  are  marked  enougk  to  recognize  the 
disease,  but  in  cases  seen  where  the  patient  has  had  it  for  some  time,  un- 
recognized, it  is  difficult  to  make  the  diagnosis.  The  first  symptom  com- 
pained  of  is  an  inability  to  walk  straight.  Persons  can't  step  where  they 
■want  to.  They  have  an  inclination  to  run  forward,  also  a  sudden  contrac- 
tion of  the  muscles  of  the  back  which  may  almost  throw  the  sufferer  out 
of  bed.  Later  on  a  reddish  rash  appears,  and  this  is  characteristic  of 
pellagra  in  that  it  appears  upon  the  same  spot  on  both  hands,  arms  or 
sides  of  the  chest,  etc.  Another  marked  symptom  is  the  salty  taste  in 
the  mouth,  the  mouth  also  is  inflamed,  patient  also  complains  of  great 
wearines  and  expresses  it  as  "leg  tire."  The  patient  is  dull,  cannot  think 
quickly  and  dizziness  is  complained  of.  Pain  occurs  along  the  spinal 
column. 

Prevention  of  Pellagra. — Avoid  eating  corn  bread  or  meal  unless 
sure  that  the  corn  is  fresh  and  has  not  undergone  "heating."  Avoid 
alcoholic  drinks.  All  flies  and  mosquitoes  must  be  killed,  as  they  may 
carry  the  poison  which  causes  the  disease,  and  their  breeding  places  must 
be  removed.  It  is  not  necessary  to  isolate  a  patient  from  his  family, 
but  the  ordinary  precautions  of  disinfecting  the  hands  after  handling  the 
patients,  his  or  her  clothes,  etc.,  should  be  followed.  A  physician  should 
be  summoned,  as  the  treatment  requires  such  skillful  handling  that  no 
layman  can  cure  himself  with  any  known  remedy.  A  sufferer  can  only 
recover  by  following  a  course  mapped  by  his  physician,  as  to  diet,  mode  of 
living  and  medicines  to  be  taken. 

Pellagra  and  Com — The  scientists  of  Italy  and  Eoumania  where 
pellagra  has  existed  for  upwards  of  one  hundred  years,  state  that  when 
com  is  harvested,  while  the  ear  is  yet  moist,  because  of  not  having  been 
given  time  to  dry  out  in  the  field,  it  is  particularly  apt  to  mildew  in  the 
barn.  The  same  thing  is  true  of  even  matured  corn  in  particularly  moist 
climates.  When  corn  that  is  damp  from  any  cause  is  placed  in  tight  barna 
or  cars  for  shipping,  it  is  likely  to  mold.  This  mold  is  extremely  danger- 
ous, regardless  of  what  may  be  the  cause  of  its  development.  The  presenco 
of  the  mold  may  be  determined  by  any  individual,  for  it  is  none  other  than 
the  mustiness  that  we  have  all  smellcd  in  corn  upon  occasion.  That  musty 
odor  is  the  warning  of  the  presence  of  a  danger  that  cannot  be  over- 
estimated. 


31G  THE  ERUPTIVE  DISEASES. 


MAXARIAL  FEVERS. 

ITndcr  this  groiiji  are  inohidcd  infectious  diseases  caused  by  a  para- 
site Plasmodia,  which  are  spread  from  one  person  to  another  by  the  bite  of 
the  niosqiiito  (anoplieles  maculopennis)  which  contains  the  parasite  in 
its  body,  llaharial  fevers  are  spoken  of  by  the  public  as  ague,  swamp 
fever,  cliills  and  fever,  etc.  The  malarial  fevers  occur  in  periodic  at- 
tacks and  are  classified  as :  (1)  regularly  intermittent  periodic  fever  of  the 
tertian  or  quarter  tyj)e;  (2)  irregular  fever  of  remittent  or  continued 
type;  (3)  chronic  malaria  or  a  condition  resulting  from  repeated  attacks 
of  malaria  with  ana?mia  and  enlargement  of  the  spleen. 

Etiology. — Influences  predisposing  to  the  spread  of  the  disease.  Con- 
ditions which  favor  the  development  of  the  mosquito  as  heat  and  moisture 
found  in  stagnant  pools,  lakes,  rivers  or  any  still  body  of  water.  Areas 
of  special  prevalence  are  found  in  tropical  and  subtropical  countries — 
Panama,  Central  America,  India,  ISTorthern  Africa,  especially  along  the 
coast  and  river  basins.  Malaria  is  prevalent  along  the  shores  of  rivers  in 
the  Southern  States  of  the  United  States,  particularly  along  the  Gulf 
States.  Malarial  fevers  have  almost  disappeared  from  New  England  and 
New  York.  It  is  very  infrequent  in  eastern  Pennsylvania,  New  Jersey 
and  Maryland.  The  Northwestern  States,  the  Pacific  coast,  and  the 
regions  north  of  the  St.  Lawrence  Piver  are  practically  free  from  malaria. 

Season. — In  the  tropics  malarial  fevers  are  most  prevalent  during  the 
rainy  season.  In  temperate  climates  a  few  cases  occur  in  the  sj^riiig,  the 
greater  number  of  cases  occur  in  the  early  autumn. 

locality. — Malarial  fevers  occur  more  in  the  country  or  outlying  dis- 
tricts of  a  large  city.  This  is  due  to  the  fact  that  the  anopheles  maculo- 
pejinis,  the  only  species  of  mosquito  which  conveys  the  parasite,  breed  in 
small,  shallow  pools  and  stagnant  waters.  The  culcinioc,  the  mosquito 
seen  about  the  home  in  suburbs  or  cities  free  from  marsh  lands,  etc.,  do 
not  carry  the  parasite  of  malaria.  They  prefer  human  habitations  and 
deposit  their  eggs  in  still  water  which  is  allowed  to  stand  in  rainpipes 
roof  gutters,  cesspools,  barrels  and  other  containers  about  the  premises. 
Hence  malaria  is  more  prevalent  outside  of  cities. 

The  cause  of  malarial  fevers  was  discovered  in  1880  by  Doctor 
Laveran,  a  French  army  surgeon  in  Algiers.  He  examined  the  blood  of 
patients  suffering  from  chills  and  fever  and  found  the  parasite  which 
caused  the  s}nu])toms  was  present  in  every  case.     This  tiny  parasite  has 


MALARIAI^  FEVERS.  31 7 

been  termed  the  Plasmodium  Malarisi.  It  has  been  discovered  and  proven 
that  the  parasites  causing  mahirial  fever  have  a  definite  course  and  de- 
velopment in  the  blood  of  man  and  the  hodj  of  the  mosquito. 

The  Parasite  in  Man — Three  species  of  parasites  are  recognized  as 
causing  the  dift'erent  types  of  fevers  in  sufferers  from  malaria;  (a)  tlie 
tertian  is  caused  by  the  Plasmodium  Vivax ;  (b)  the  quartan  by  the  Plas- 
modium Malaria;  (c)  the  estivo-autumnal  (Perincenis)  by  the  Plas- 
modium Immaculatum. 

The  Tertian  Parasite  {Plasmodium  Vivax). — This  species  when  in- 
jected into  the  blood  of  a  person  by  the  bite  of  a  mosquito — the  anopheles 
maeulopcnnis — causes  a  fever  which  occurs  every  forty-eight  hours.  The 
fever  residts  from  the  parasite  imdergoing  a  development  in  the  red  cells 
of  the  blood,  in  which  new  parasites  are  developed  at  the  same  time,  de- 
stroying the  cells,  then  they  attack  fresh  cells,  at  which  times  the  fever 
develops  and  they  repeat  this  imtil  treatment  is  Instituted.  But  the  ter- 
tian parasite  never  causes  chills  or  fever  vmtil  its  period  of  development  is 
completed — forty-eight  hours. 

The  Quartan  Type  (Plasitwdiiun  Malaria). — This  species  also  carried 
by  the  mosquito  is  the  cause  of  quartan  fever.  Its  cycle  of  development 
in  the  red  blood  cells  of  man  is  seventy-two  hours,  when  the  new  parasites 
are  liberated  and  attack  fresh  blood  cells,  thus  causing  chills  and  fever 
once  every  seventy-two  hours. 

The  Estivo-Autunmal  Parasite  (Plasmodium  Immaculatum). — This 
parasite  is  the  cause  of  estivo-autumnal  fever  {Perincenis),  which  is  the 
most  malignant  type  of  malarial  fever.  It  is  conveyed  by  the  bite  of  the 
mosquito — anopheles  macidopennis.  Its  development  takes  place  in  the 
red  cells  of  the  blood  in  the  liver,  spleen  and  bone-marrow,  and  usually 
requires  forty-eight  hours  to  develop.  This  parasite  will  not  caiise  a  great 
deal  of  fever,  but  a  continuous  one  which  lasts  for  some  time  and  goes  up 
very  high  and  remains  up  until  recovery  occurs,  when  it  drops  suddenly. 

The  parasites  of  tertian  fevers  can  only  be  seen  by  withdrawing  the 
blood  from  a  finger  or  lobe  of  the  ear  and  examining  it  under  the  micro- 
scope. The  estivo-autumnal  parasite  is  not  often  found  in  the  peripheral 
blood  of  the  body.    Each  parasite  causes  its  own  type  of  fever  and  no  other. 

The  Parasite  in  the  Mosquito — The  connnon  species  of  mosquito  which 
carries  and  spreads  malaria  is  the  anopheles  maculopennis.  There  are 
many  species,  but  wherever  malaria  is  found  the  anopheles  is  always  in 
the  neighborhood.  The  anopheles  cannot  convey  malaria  unless  it  has 
sucked  the  blood  of  a  patient  suffering  from  malaria.     Its  bite  ahme  docs 


318  THE  EETJPTIVE  DISEASES. 

uot  caiise  the  disease  unless  it  has  the  jiarasite  in  its  body,  and  the  para- 
site does  uot  develop  in  cold  climates.  Thus  the  anopheles  can  live  in 
regions  not  malarious  and  still  be  harmless,  but  should  one  of  this  species 
bite  a  sufferer  of  malaria,  who  recently  arrived  and  had  the  parasite  in  his 
blood,  then  the  mosquito  could  spread  the  disease  by  biting  another  person. 

Persons  living  in  malarious  countries  should  be  familiar  with  the 
habits  and  appearance  of  the  mosquitoes  seen  within  the  house  or  about 
the  premises.  The  culex  or  ordinary  mosquito  which  is  not  a  carrier  of 
malaria  can  be  recognized  by  its  position  from  the  anopheles  maculo- 
pennis.  The  former  rests  upon  the  ceiling  or  wall  with  its  posterior  pair 
of  legs  turned  up  over  its  back,  and  the  body,  if  not  dragged  down  by  the 
■weight  of  blood,  is  nearly  parallel  with  the  wall.  Its  wings  show  no  spe- 
cial marking.  The  anopheles  maculopennis,  when  resting,  places  the 
posterior  pair  of  legs  upon  the  wall  or  ceiling  or  allows  them  to  hang  down, 
and  the  body  is  held  at  an  angle  of  45  degrees  with  the  surface  upon  which 
it  rests.     The  wings  of  this  species  show  distinct  markings. 

Part  Played  by  Mosquito  in  Spreading  Malaria — Let  us  take,  for 
example,  a  man  suffering  from  the  tertian  type  of  malarial  fever.  In 
forty-eight  hours  the  malaria  parasite  has  undergone  a  development, 
sexual  and  non-sexual,  in  the  man's  red  blood  cells,  thus  forming  new 
jiarasitcs.  The  non-sexual  developments  have  formed  spores,  these  spores 
find  their  way  into  a  red  cell  and  begin  the  sexual  development,  which 
progresses  until  the  cell  develops  into  a  different  shape,  called  Garaetocyte, 
now  the  mosquito  bites  this  patient  and  takes  into  his  stomach  these 
Gametocytes,  which  are  at  this  time  of  both  sexes — male,  the  Microgamiti, 
female,  Macrogamet.  The  cells  reproduced  by  the  Macrogameti  penetrat- 
ing the  body  of  the  Macrogamet,  a  single  cell  resulting — called  the  Zygote, 
the  latter  passes  into  the  wall  of  the  stomach  of  the  mosquito,  when 
it  develops  in  an  oocyst  containing  sporeblasts  which  develop  into  sporo- 
zoites.  The  mature  oocyst  bursts  and  these  accumulated  sporozoites  reach- 
ing the  circulation  of  the  mosquito  are  carried  to  the  salivary  glands,  and 
when  the  mosquito  bites  a  fresh  victim,  he  injects  the  young  sporozoites 
into  his  blood  through  his  proboscis  as  he  sucks  the  blood,  and  the  develop- 
ment of  the  parasite  is  repeated,  as  in  the  first  patient. 

Symptoms — Malaria  usually  develops  in  a  person  in  from  a  few 
days  to  two  weeks  after  being  bitten  by  a  mosqiiito.  The  symptoms  of  the 
tertian  and  quartan  types  are  practically  the  same,  and  are  spoken  "of  as 
the  paroxysm. 


MALARIAL  FEVERS.  319 

The  paroxysm  is  knowTi  as  the  chill  or  "ague  fit,"  and  is  described 
under  three  stages :  cold,  hot  and  the  sweating. 

Cold  Stage — During  this  period  the  patient  at  first  complains  of 
loss  of  energy,  yawning,  pain  in  the  pit  of  the  stomach,  sometimes  nausea 
and  vomiting  with  headache.  Shivering  conmipuces  which  develops  into 
a  chill.  The  teeth  chatter,  there  is  violent  shaking  of  the  whole  body,  and 
distressing  sensations  of  extreme  cold.  The  face  is  blue,  the  body  is  cov- 
ered with  goose-flesh,  the  temperature  of  the  surface  of  the  skin  is  sub- 
normal. This  stage  lasts  from  fifteen  minutes  to  an  hour  or  more.  The 
danger  of  the  attack  lies  in  how  long  the  cold  stage  has  progi-essed. 

Hot  Stage. — The  cold  sensations  are  replaced  by  those  of  heat.  The 
face  becomes  flushed  and  the  fever  is  high,  101  to  lOi  degi-ees  Fahren- 
heit, the  pulse  is  free  and  strong,  headache  is  present  and  delirium  occurs 
in  some  cases.  The  patient  complains  of  urgent  thirst  and  is  distressed  by 
the  sensations  of  extreme  heat  which  he  feels  within  the  body.  The  dura- 
tion of  this  stage  usually  lasts  from  thirty  minutes  to  three  or  four  hours. 

Sweating  Stage. — Perspiration  appears  upon  the  forehead  and  face, 
later  the  entire  body  is  drenched.  The  duration  of  this  stage  is  variable. 
The  patient  finally  falls  into  a  sleep,  from  which  he  awakes  very  weak, 
but  refreshed. 

The  entire  paroxysm  may  last  from  two  to  six  hours  depending  upon 
the  severity  of  the  attack.  Between  the  paroxysms  the  patient  feels  well 
and  considers  himself  in  normal  health.  The  paroxysms  are  due  to  the 
breaking  down  of  the  red  cells  and  the  liberation  of  a  poison  from  the 
parasites,  produced  during  the  maturity  of  the  parasites  in  the  red  blood 
cells  of  the  sufferer;  also  the  liberation  of  the  new  parasites  (Sporozoites). 
A  paroxysm  which  occurs  every  forty-eight  hours  in  malaria  is  due  to 
the  presence  in  the  blood  of  the  tertian  parasite,  and  it  is  called  tertian 
fever.  A  paroxysm  occurring  every  seventy-two  hours  is  due  to  the 
presence  in  the  blood  of  the  quartan  parasite ;  then  we  speak  of  this  as 
quartan  fever.  In  some  cases  of  malaria,  a  paroxysm  occurs  every  day 
(quoditian  fever).  Then  it  is  due  to  the  fact  that  two  gi-oups  of  parasites 
are  present,  which  undergo  segmentation  on  alternate  days.  This  is 
spoken  of  as  a  doiible  tertian  period. 

Tf  two  groups  of  the  quartan  parasite  are  present  in  the  blood,  the 
paroxysms  occur  every  seventy-two  hours  on  alternate  days,  thus  there 
will  be  two  days  of  chills,  fever  and  sweats,  with  a  day  in  between,  free 
from  an  attack.     This  is  spoken  of  as  a  double  quartan;  if  three  groups 


320  THE  ERUPTIVE  DISEASES. 

are  present  there  ■will  be  a  daily  attack  (Quotidian  Fever),  this  is  called 
a  triple  quartan. 

The  Estivo-Autumnal,  or  Perincenis  Malarial  Fever — This  type  of 
fever  prevails  in  southern  Italy  and  Russia,  tropical  countries  and  the 
Gulf  section  of  the  United  States.  It  usually  develops  in  the  last  part 
of  the  summer  or  early  autumn.  It  is  characterized  hy  irregularity  due 
to  tlie  parasites  in  the  blood,  which  have  a  cycle  of  development  of  about 
forty-eight  hours,  being  in  numbers  or  groups  and  does  not  mature  upon 
certain  definite  days.  The  intensity  is  due  to  the  dangerous  nature  of 
the  poison  produced  by  the  parasite  at  the  time  of  the  sporulation  of  the 
numerous  groups. 

Symptoms — The  sufferer  from  the  estivo-autumnal  type  of  malarial 
fever  does  not  have  a  paroxysm  occurring  at  regular  intervals,  but  suffers 
from  a  high  fever,  which  begins  and  stays  high  ujitil  recoveiy.  There 
may  be  no  chills  but  fever  and  sweats  are  symptoms.  The  face  is  flushed, 
severe  lieadache  is  present,  the  pulse  is  bounding  and  enlargement  of 
the  spleen  occur.'j.  Jaundice  of  the  skin  is  seen.  This  fever  may  be 
very  mild,  or  the  j)atient  may  suffer  from  a  severe  form.  The  most 
dangerous  types  of  estivo-autumnal  fever  are  gi-ouped  under  the  perincenis 
fevers.  These  are  characterized  by  grave  symptoms  and  unless  properly 
treated  and  protected  against  reinfection  may  result  in  death.  These 
types  of  perincenis  malaria  are  called  (1)  Algid  form,  (2)  comatose  fonu, 
(8)  hemorrhagic  form. 

Malarial  Cachenia  or  Chronic  Malaria — This  is  a  condition  of  health 
occurring  in  patients  who  have  had  and  been  exposed  to  malaria  numliers 
of  times  and  did  not  receive  proper  treatment  and  protection  from  the 
bite  of  the  mosquito  which  carries  the  parasite.  It  is  characterized  by 
an  ana-mia  (thinning  of  the  blood),  OTtli  enlargement  of  the  spleen. 
The  patients  are  very  thin  and  lose  weight,  the  coiuplexion  is  muddy 
with  brown  spots  in  the  skin.  Shortness  of  breath  occurs  upon  slight 
exertion,  and  the  ankles  are  usually  swollen.  The  spleen  becomes  so 
large  that  it  resembles  a  tumor  kno\vii  in  the  Southern  states  as  "Ague 
Cake."    Vomiting  of  blood  may  occur  and  is  usually  fatal  if  a  symptonu 

Treatment. — In  the  tertian  and  quartan  types  quinine  is  given  in 
15  to  30  grain  doses  (preferably  in  solution),  at  the  time  the  temperature 
declines  and  repeated  if  necessary  upon  the  follo\\'ing  day.  The  treatment 
should  be  continued  for  at  least  a  month,  but  the  dose  must  be  gradually 
reduced.  Keep  this  up  liowever  if  the  paroxysms  occur  or  the  parasite 
is  seen  in  the  blood  of  a  patient  when  examined  under  a  microscope. 


MALARIAI,   FEVEES.  321 

In  the  estivo-autumnal  type  quinine  should  be  given  in  five-grain 
doses  every  four  hours  imtil  the  active  symptoms  have  cleared  up,  then 
five  grains  every  six  hours  for  the  next  three  days.  During  the  following 
week  the  patient  must  receive  15  grains  once  a  day  every  other  day,  and 
for  two  mouths,  following  give  15  grains  every  sixth  day  until  all  danger 
is  passed.  In  this  way  the  disease  can  he  cured.  Also  be  sure  that  the 
patient  is  protected  from  reinfection  or  moves  away  from,  the  malarious 
country  until  cured.  I>o  not  stop  quinine  treatment  until  parasites  cannot 
be  found  in  blood,  and  chills  and  fever  and  enlarged  spleen,  etc.,  are 
absent. 

Treatment  of  Malarial  Caehenia,  or  Chronic  Malaria. — Quinine,  iron, 
arsenic  and  various  tonics  have  been  used,  but  the  best  treatment  is  to 
remove  to  a  non-malarious  country  with  a  high  altitude  and  avoid  living 
again  in  a  nxalarious  country.  Sufferers  from  malarial  fever  will  recover 
more  qiiickly  if  confined  to  bed.  Quinine  acts  in  curing  malaria  by 
directly  destroying  the  malarial  parasite. 

Prevention  of  Malarial  Fevers. — As  malaria  microbes  are  carried 
from  one  person  to  another  by  the  mosquito  (Anopheles  Maculopennis) 
its  spread  can  be  prevented  by  destroying  the  mosquito,  screening  all 
doors  and  windows,  etc.,  wearing  clothing  which  protects  the  body  com- 
pletely, wearing  a  mosquito  helmet  over  the  head  and  face,  or  smearing 
oil  of  citronella  over  the  face  and  hands  at  intervals. 

If  choosing  a  site  for  a  house  or  camp,  or  any  building,  high,  dry 
ground  should  be  selected,  away  from  all  still  bodies  of  water,  if  possible 
drain  all  stagnant  pools,  etc.,  fill  in  with  earth  water  which  cannot  be 
drained  and  prevent  mosquitoes  from  laying  their  eggs  in  these  hiding 
places.  Kerosene  freely  used  about  the  premises  upon  any  still  body 
of  water  will  prevent  the  development  of  the  anopheles  and  thus  destroy 
the  common  carrier  of  malaria. 

Persons  living  or  traveling  and  exposed  to  malaria  can  oftentimes 
protect  themselves  from  contracting  the  disease,  even  though  exposed  to 
the  bites  of  the  mosquito,  by  taking  five  to  ten  gi'ains  of  quinine  once  a 
day,  two  or  three  days  a  week.  Of  course  some  people  contract  the 
disease  regardless  of  this  precaution.  See  Part  T  of  "Book  TIT  (Preventive 
Medicine  for  further  habits  of  the  mosquito  and  methods  of  destruction. 
21 


332  THE  EKUPTIVB  DISEASES. 


AGUE  OR  INTERMITTENT  FEVER. 


Agne  or  Intermittent  fever  is  invariably  prevalent  in  swampy  coun- 
tries. In  olden  times  it  Avas  attributed  to  the  insects  rising  at  night-time 
from  the  swampy  ground,  but  now  it  is  known  that  it  is  obtained  only  by 
means  of  the  mosquito,  which  finds  its  best  breeding  place  in  swamps  and 
still  waters.  It  is  to  be  observed  that  it  is  only  the  female  mosquito  which 
is  able  to  impregnate  malaria  in  the  human  victim. 

Symptoms. — Characterized  by  three  distinct  stages  of  fever,  chill  and 
sweat.  The  paroxysm  is  usually  preceded  by  a  feeling  of  uneasiness  and 
discomfort,  sometimes  langour  and  yawning,  which  forewarns  the  patient 
of  its  coming. 

1.  The  Clull  or  Cold  Stage. — ^Begins  gradually ;  first  there  is  a  creep, 
then  another,  a  little  more  severe,  then  another,  each  growing  in  severity 
until  the  teeth  chatter  and  the  body  shakes  violently.  Not  only  does  the 
patient  look  cold,  but  a  surface  thermometer  will  indicate  a  reduction  of 
the  skin,  temperature.  The  rectal  temperature  during  the  chiU  may  be 
greatly  increased.    It  lasts  from  fifteen  minutes  to  an  hour. 

2.  The  Hot  Stage. — ISText  comes  the  hot  stage,  in  which  all  the 
symptoms  of  fever  are  manifested,  comprising  headache,  nausea  or  vomit- 
ings heat  of  skin,  which  may  attain  an  elevation  of  105  degrees,  full, 
strong,  rapid  pulse  and  occasionally  delirium  lasting  from  a  half  hour 
to  four  hours.  After  this  follows  the  sweating  stage,  during  which  pro- 
fuse perspiration  takes  place  and  the  temperature  is  reduced,  as  a  con- 
sequence, nearly  or  quite  to  the  natural  standard.  The  paroxysms,  thus 
constituted,  generally  recur  with  considerable  regiilarlty,  but  may  vary 
a  good  deal  in  different  cases  in  regard  to  the  interval  between  each  par- 
oxysm. 

Varieties  of  Ague — The  varieties  of  ague  designated  in  accordance 
with  this  difference  are,  first,  the  quotidian  or  daily  ague,  in  which  the  fit 
comes  on  usually  at  the  same  hour  every  day;  second,  the  tertian  ague, 
the  most  common  form,  when  the  paroxysm  returns  every  forty-eight 
hours  whilst  the  disease  continues ;  third,  the  quartan,  where  the  fit  occurs 
every  seventy-two  hours,  or  on  every  fourth  day;  and  fourth,  the  Irregular 
ague,  in  which  the  fits  are  not  distinctly  periodical.  Under  this  head  Is 
included  the  kind  of  periodical  neuralgia  affecting  the  forehead,  and  hence 
denominated  brow-ague.    In  the  quotidian  form  the  paroxysm  is  apt  to  be 


IKTEEMITTENT  FEVEB.  323 

the  most  prolonged  and  may  last  for  sixteen  hours  ont  of  the  twenty-four, 
leaving  of  course  only  eight  hours  between  its  termination  and  the  com- 
mencement of  a  new  chill;  in  the  tertian  form,  the  fit  is  less  protracted, 
lasting  on  an  average  about  ten  hours ;  and  in  the  quartan  it  is  stiU  shorter, 
having  an  average  duration  of  only  six  hours.  In  a  fit  of  tertian  ague 
continuing  ten  hours,  we  may  expect  to  find  the  chill  lasting  from  half 
an  hour  to  an  hour,  the  febrile  stage,  during  which  the  patient  often  de- 
clares he  feels  as  thoiigh  he  were  burning  up,  extending  over  from  three 
to  five  hours  and  the  sweating  stage  occupying  the  remainder  of  the  time. 
Complications. — The  most  common  secondary  affection  which  occurs 
in  the  course  of  Intermittent  fever,  and  appears  to  be  directly  dependent 
upon  it,  is  the  chronic  enlargement  of  the  spleen,  called  "ague-cake." 
During  the  cold  stage  of  the  fit,  It  Is  probable  that  the  spleen  Is  always 
more  or  less  distended  with  blood,  which,  being  driven  from  the  surface 
of  the  body  whilst  the  chill  lasts,  finds  its  way  to  the  Internal  organs  and 
especially  the  spleen,  in  unusual  quantity.  Such  congestion,  if  frequently 
repeated,  seems  to  lead,  In  a  majority  of  cases,  to  a  z'eal  increase  in  amount 
of  the  structure  of  the  spleen,  and  consequent  enlargement  of  the  organ. 
The  Ague-Cake. — The  "ague-cake,"  when  fully  developed,  may  attaia 
a  magnitiide  of  a  foot  or  more  in  length  by  ten  Inches  in  breadth,  and  even 
when  much  smaller  than  this  may  be  felt  as  a  hard,  painful  and  movable 
tumor,  on  the  left  side  of  the  abdomen,  a  few  inches  below  the  heart. 
Such  increase  in  size  of  the  spleen  generally  indicates  a  rather  profound 
impression  of  the  malarial  poison  upon  the  system,  and  renders  the  pros- 
pect of  speedy  cure  far  less  hopeful. 

lack  of  Blood. — ^Another  serious  complication  of  prolonged  ague  is 
the  intense  anemia,  which  so  many  persons  who  suffer  from  malarial 
[poisoning  often  exhibit  to  a  marked  degree.  The  absence  of  the  natural 
supply  of  good,  rich,  red  blood  gives  td  the  skin,  and  especially  that  of  the 
face,  a  dull,  yellowish  tint,  which  in  malarious  regions  is  displayed  by 
most  of  the  Inhabitants,  even  the  children  exhibiting  a  pallid  sallowness 
pitiful  to  behold.  There  is  also  a  peculiar  dejected,  woe-begone  expres- 
sion of  countenance,  which  is  almost  characteristic  of  malarial  poisoning, 
and  feelings  of  muscular  weakness  and  fatigue  on  the  slightest  exertion  arei 
very  common. 

[Diagnosis. — The  diagnosis  of  ague  Is  seldom  difficult  after  the  first 
paroxysm,  as  the  regular  recurrence  at  the  same  hour  of  the  day  Is  a 
feature  which  Is  so  characteristic  that  it  has  given  the  name  of  "periodical 
ifevers"  to  the  febrile  affections  caused  by  malaria.     At  the  first  enset,  it 


324  THE  iOKUPTIVE  DISEASES. 

is  impossible  to  distinguish  the  chill  from  the  initial  symptom  of  a  gi'eat 
iiiimlier  of  diseases,  but  a  microscopical  examination  of  the  blood  will 
quickly  decide.  The  plasmodium  of  malaria  is  found  in  the  blood  during 
the  paroxysms. 

Treatment. — In  the  medical  treatment  of  all  the  periodical  fevers,  we 
fortunately  possess  a  specific  of  wonderful  power  in  quinine  and  the  other 
alkaloids  of  Peruvian  bark,  which  have  a  direct  control  over  the  malarial 
poison,  by  checking  the  development  of  the  hacillus  malarioe,  which  has 
been  already  referred  to  as  being  the  cause  of  ague. 

Quinine  Treatment — It  is  the  custom  to  j)repare  the  system  for  the 
administration  of  quinine,  by  the  purgative  action  of  full  doses  of  blue- 
jiill  or  other  active  cathartic.  Give  quinine  in  sufficient  doses,  during 
the  sweating  stage,  to  produce  the  slight  deafness  and  ringing  in  the  ears 
which  mark  the  occurrence  of  cinchonism,  as  it  is  denominated.  As  a 
general  rule,  it  is  quite  possible  to  do  this  before  the  time  for  another 
paroxysm,  even  with  an  attack  of  intermittent  fever  of  the  quotidian  type. 
The  antiperiodic  must,  however,  in  order  to  effect  a  cure,  be  continued 
in  full  doses  of  from  ten  to  thirty  gi-ains  daily,  for  three  or  four  days,  then 
reduced  to  half  or  one-third  this  quantity  for  a  few  days,  and  so  per- 
severed in  for  throe  weeks. 

Preventing  Fever  Recurrence. — For  the  purpose  of  counteracting  the 
tendency  which  intermittent  fever  possesses  of  recurring  in  its  original 
violence  at  intervals  of  exactly  one  week,  it  is  advisable  to  take  the  full 
dose  of  from  ten  to  thirty  grains,  or  whatever  amount  has  been  found 
to  produce  slight  buzzing  in  the  ears,  on  the  sixtli  and  seventh,  the  thir- 
teenth and  fourteenth,  and  the  twentieth  and  twenty-first  days  from  that 
on  which  the  last  chill  was  experienced.  In  this  way  not  only  the  peri- 
odicity of  single  ague-fits,  but  also  the  periodicity  of  groiips  of  the  inter- 
mittent fever  paroxysms,  appears  to  be  most  effectually  extinguished. 

An  East  Indian  Cure. — In  case  quinine  fails  or  is  not  tolerated,  other 
alkaloids  of  Peruvian  bark,  and  preparations  of  the  bark  itself,  should 
be  fairly  tried.  A  famous  East  Indian  mixture  for  the  cure  of  ague  is 
Warburg's  tincture,  and  it  may  be  resorted  to  when  ill-success  with  other 
forms  has  been  met  with. 

Use  of  Peruvian  Bark — The  alkaloids  of  Peruvian  bark  are,  as  a  rule, 
much  more  efiicacious  in  solution  with  some  mineral  acid,  such  as  the 
dilute  sulphuric  acid. 

Other  Treatments — Where  for  any  reason  Peruvian  bark  and  its 
preparations  fail  to  cure  ague,  the  best  substitute,  although  a  far  inferior 


EEMITTENT  OR  CONTINUED  FEVERS.  325 

one,  is  probably  arsenic,  particularly  in  the  form  of  Fowler's  solution, 
administered  in  quantities  of  five  drops  thrice  daily,  and  formerly  well 
known  under  the  name  of  the  tasteless  ague-drop.  For  the  cold  stage, 
wrap  the  patient  up  well  in  blankets  and  apply  hot-water  bags,  besides 
giving  hot  drinks.    For  the  fever,  cool  sponging  will  relieve  the  patient. 

Diet. — No  particular  care  of  the  diet  is  requisite  in  intermittent  fever, 
except  to  counteract  as  far  as  possible  the  tendency  to  anemia  and  general 
debility,  by  a  liberal  supply  of  the  most  nutritious  food  which  the  diges- 
tive powers  are  able  to  assimilate.  In  like  manner,  as  the  patient  is  not 
confined  to  bed,  directions  about  nursing  are  imnecessary. 

Prevention  of  Ague — Tlie  remedy  to  be  used  in  preventing  an  attack 
of  malarial  poisoning,  when  temiDorary  residence  in  a  fever  and  ague 
district  is  unavoidable,  is  quinine  used  internally,  as  already  suggested, 
in  doses  of  six  or  eight  grains  daily. 

THE  MORE  IRHEGTJLAR,  REMITTENT  OR  CONTINUED  FEVERS. 

Place  and  Seasons. — This  type  of  fever  occurs  in  temperate  climates, 
chiefly  in  the  later  summer  and  fall;  therefore  it  is  sometimes  called 
estivo-autumnal  fever.  The  severer  forms  of  it  prevail  in  the  Southern 
States,  where  it  is  known  as  the  bilious  remittent  fever.  The  entire 
group  of  cases  included  under  the  term  remittent  fever  are  bilious,  re- 
mittent and  typho-malarial  fevers. 

Symptoms. — These,  as  to  be  expected,  are  often  irregular.  In  some 
instances  there  may  be  regular  intennittent  fever,  occuring  at  uncertain 
intervals  of  from  twenty-four  to  forty-eight  hours,  or  even  more.  In  the 
cases  with  longer  remissions  the  paroxysms  are  longer.  Commonly,  how- 
ever, the  paroxysms  show  material  differences;  their  length  averages  over 
twenty  hours,  instead  of  ten  or  twelve;  the  onset  occurs  often  without 
chills  and  even  withovit  chilly  sensations.  The  rise  in  temperature  is 
usually  gradual  and  slow,  instead  of  sudden,  while  the  fall  may  occur  by 
lysis  instead  of  by  crisis.  There  is  a  marked  tendency  to  anticipation, 
while  frequently  from  anticipation  of  one  paroxysm  and  retardation  of 
another  more  or  less  continuous  fever  may  result.  In  the  cases  of  con- 
tinuous and  remittent  fever  the  patient,  when  seen  early  in  the  disease, 
has  a  flushed  face  and  looks  ill,  the  tongue  is  furred,  the  pulse  full  and 
bounding,  but  rarely  dicrotic.  The  temperature  may  range  from  102 
degrees  to  103  degrees  or  go  even  higher. 

Diagnosis. — The  diagnosis  of  remittent  malarial  fever  may  be  def- 


326  THE  ERUPTIVE  DISEASES. 

initely  made  by  an  examination  of  the  blood.  The  small,  actively,  motile, 
hyaline  forms  of  the  estivo-autiimnal  parasite  are  to  be  found,  while  if 
the  case  has  lasted  over  a  week,  the  larger  cresentic  and  ovoid  bodies  are 
usually  seen. 

Treatment The  treatment  of  remittent  fever  is  essentially  that  of 

intermittent  fever.  The  continued  nature  of  the  fever  and  the  tendency 
to  a  typhoid  state  demands  a  liquid  diet,  with  the  careful  addition  of 
stimulants. 

PERNICIOTJS  MALARIAL  FEVER  OR  CONGESTIVE  CHILL. 

Character. — Pernicious  malarial  fever  differs  in  no  respect  from  or- 
dinary ague  and  bilious  remittent,  except  in  its  greater  severity.  The 
disease  is  observed  under  three  forms:  First,  the  comatose  or  apoplectic 
form,  the  patient  speedily  loses  consciousness,  as  though  the  chief  force 
of  the  poison  was  expended  upon  the  brain,  disturbing  its  functions  to 
such  an  extent  as  almost  to  abolish  them.  The  fever  is  usually  high  and 
the  skiu  hot  and  dry.  Should  the  patient  regain  consciousness  a  second 
attack  may  come  on  and  prove  fatal. 

Second  Form — In  the  second  or  algid  form  the  symptoms  of  intense 
chill  are  prolonged,  it  may  be  for  some  hours,  and  death  occurs  in  fatal 
cases  from  pure  debility  or  asthenia,  without  reaction  coming  on.  Al- 
though the  patient  is  apathetic,  the  mind  remains  clear  to  the  last.  Vom- 
iting and  purging  are  the  prominent  symptoms,  and  the  disease  might 
readily  be  mistaken  for  Asiatic  cholera,  if  it  happened  to  occur  whilst  an 
epidemic  of  that  malady  was  raging,  were  it  not  that  the  urine  is  never 
albuminous. 

The  Hemorrhagic .  Form — In  the  third  group  of  cases,  denominated 
hemorrhagic  malarial  fever,  the  prominent  peculiarity  is  bleeding,  gen- 
erally from  the  kidneys,  but  sometimes  from  the  stomach,  bowels,  nose 
and  mouth. 

Diagnosis. — As  one  might  expect,  the  blood  shows  marked  changes  in 
malarial  fever.  In  the  regular  intermittent  type  there  is  a  loss  in  the 
red  corpuscle  after  each  paroxysm,  which  may  be  considerable,  but  which 
is  rapidly  compensated  for  during  the  intermissions.  In  the  estivo- 
autunmal  fever  the  losses  are  often  greater  and  more  permanent. 

Treatment. — As  in  the  other  kinds,  give  quinine,  but  in  larger  doses. 
In  the  case  of  the  pernicious  disease  to  get  the  effect  more  rapidly  give 
quinine  hypodermically  as  much  as  thirty  grains  at  a  time.  Excessive 
care  must  be  used  to  avoid  abscesses. 


OHOLEBA  MOEBtJb.  327 

Quinine    sulphate     60  grains 

Saturated  solution   tartaric   acid    68  drops 

Distilled  water  to  make  2  drachms. 
Take  30  drops  three  times  daily. 

In  addition  to  the  use  of  quinine,  stimulants  must  be  given  for  the 
asthenia,  artificial  heat  for  the  low  temperature.  Morphine  hypoder- 
mically  to  relieve  pain  and  allay  nausea. 

CHOLERA  MORBUS. 

Definition — An  acute  gastro-intestinal  catarrh,  characterized  *by  pro- 
fuse vomiting,  purging  and  painful  cramp. 

Causes — This  malady,  which  is  not  contagious,  occurs  at  times  almost 
as  an  epidemic,  and  is  occasionally  fatal,  so  that  no  instance  of  it,  however 
mild  at  first,  ought  to  be  allowed  to  run  on  without  treatment.  Although 
generally  induced  by  indulgence  in  indigestible  food,  especially  unripe 
fruits,  there  seems  to  be  at  certain  seasons  of  the  year  some  external  in- 
fluence promoting  the  tendency  to  disorder  of  the  bowels,  which  is  atmos- 
pheric. Especially  frequent  are  these  attacks  in  July  and  August.  Cold 
and  dampness  are  also  regarded  as  predisposing  agents. 

Symptoms The  primary  symptoms  are  uneasiness  at  the  pit  of  the 

stomach,  nausea,  retching  and  then  vomiting,  followed  by  severe  watery 
diarrhoea,  consisting  of  a  large  amoimt  of  the  watery  portions  of  the  blood, 
and  containing  only  a  little  albumen.  The  whole  system  is  thus  affected, 
in  part  by  sympathy,  but  also  to  some  extent,  it  is  probable,  by  the  change 
in  the  specific  gravity  and  constitution  of  the  blood.  The  attack  is  often 
abrupt,  a  patient  being  awakened  out  of  sleep  by  a  sudden  seizure  during 
the  night.  This  is,  however,  no  doubt  because  the  preliminary  uneasi- 
ness, nausea  and  slight  colicky  jiains,  which  manifest  themselves  in  a 
diurnal  onset  of  the  malady,  are  unfelt  in  the  unconsciousness  of  profound 
slumber.  The  vomiting  and  purging,  when  once  commenced,  recur  in 
rapid  succession,  and  sometimes  even  simultaneously,  and  enormous  quan- 
tities of  fluid  are  evacuated  from  the  system,  often  with  the  result  of 
producing  intense  thirst.  This  thirst  cannot,  however,  be  gratified  for 
some  time,  because  the  irritable  stomach  refuses  to  retain  the  smallest 
amount  of  fluid.  Collapse  may  supervene  and  the  skin  become  cold, 
clammy  and  ashen  hued,  the  eyes  sunken  and  the  pulse  frequent  and 
feeble. 

Diagnosis. — The  only  difiiculty  about  the  diagnosis  of  cholera  morbus 
or  sporadic  cholera  is  when  true  Asiatic  cholera  is  epidemic,  then,  if  a 


328 


THE  EBUPTIVE  DISEASES. 


iiiioniscopical  pxamination  of  the  dejecta  be  made,  wil!,  if  it  be  Asiatic 
c'iii>lera,  reveal  tlie  ciniima-sluiiied  bacillus. 

Treatment. — For  tlic  [lain  in  tliu  abdomen  hot  apf)lications,  morphine, 
cue-quarter  graiu,  hypodermically ;  to  be  repeated  when  necessary.  When 
the  pain  is  less  severe  opium  may  be  given  by  the  mouth  or  rectum  in  the 
form  of  laudanum — ten  drops  by  the  mouth  or  twenty-five  drops  in  a 
tablespoonful  of  thin  starch  by  the  rectum.  When  vomiting  is  the  most 
troublesome  symptom  the  following  is  beuehcial : 


Creosote   6  drops 

Bismuth    subnitrate     2  drachms 

Mix  and  put  into  13  papers.     Take  unc  every  hour. 

The  prostration  reipiires  stimulants  like  aromatic  sp'irits  of  ammonia, 
thirty  to  sixty  drops  at  a  dose  or  whiskey. 


ASIATIC  CHOLERA. 

Definition — An  acute  infectious  disease,  due  to  the  implantation  of 
the  comma  bacillus  of  Koch,  characterized  by  vomiting,  purging,  rice- 
water  evacuations  and  suppression  of  urine. 

History. — It  first  made  its  appearance  in  the  United  States  in  1832. 
Since  that   time   there   have   been   several   ej^idemics,    all   of  which   are 
traceable   to   immigration.      The   most   serious   epidemic   of   recent   time 
started  in  India  in  the  spring 
of  1892,  passing  from  thence  to 
Persia,  Austria,  Germany  and 
Holland.     A  few  cases  reached 
London  and  ISTew  York. 

Causes — The  disease- 
poison  of  cholera  undoubtedly 
reproduces  and  multiplies  itself 
during  the  course  of  the  com- 
plaint, being  propagated  by  a 
contagion,  given  off  mainly,  if 
not  entirely,  by  the  evacuations 
from  the  bowels,  in  which  the 
germs  of  disease  propagate 
themselves,  even  after  their  dis- 
charge,   so   that   the   stools   be- 


«'• 


The  Cholera  Germ. 


ASIATIC  CHOLERA.  329 

come  more  vinilent  after  they  are  passed,  especially  when  mixed  with 
water.  The  extended  researches  of  Dr.  Koch  have  proved  beyond  all  ques- 
tion the  existence  of  the  cholera  germ  {comma  bacillus)  in  drinking  water, 
and  traced  its  development  in  the  intestines  of  persons  who  had  died  of  the 
disease.  The  illustration  shows  the  ajjpearance  of  this  cholera  germ, 
which  it  is  so  important  for  every  one  at  the  peril  of  his  life  to  avoid. 
When  magnified  about  six  hundred  diameters  one  of  the  minute  intestinal 
glands  may  be  found  to  contain,  as  shown  at  a,  h  and  c,  minute  bacteria 
or  bacilli,  as  they  are  technically  called,  which,  from  their  resemblance 
to  the  cui^ved  portion  of  a  comma,  but  without  the  head  of  that  punctuation 
mark,  have  been  named  the  Comma  hacilli.  Sometimes  these  bacilli 
unite  at  their  ends  with  their  curves  turned  in  opposite  directions,  so  as 
to  produce  an  S  shape,  or  even  a  spiral  formation. 

This  Comma  Bacillus  is  the  direct  cause  of  cholera  by  its  lodgment  in 
the  intestines,  where  it  has  been  proved,  by  examination  of  nearly  one 
hundred  cases,  to  develop  with  great  rapidity.  It  is  easiest  to  detect  in 
the  earlier  stages  of  the  disease,  because  later  on  it  is  obscured  by  the 
development  of  a  great  many  other  forms  of  bacteria.  It  is  distinctive 
of  the  mildest  as  well  as  of  the  most  severe  attacks,  and  has  therefore 
an  important  diagnostic  value.  It  is  capable  of  successful  cultivation  in 
meat  broth,  in  milk,  on  slices  of  potato,  and  especially  on  gelatine,  in 
which  it  grows  in  a  singular  manner,  pi-oducing  a  gi-adual  liquefaction  of 
the  stiff  gelatine  aroimd  the  gi-owing  colony,  which  sinks  down  into  the 
jelly  in  a  peculiar  way.  The  comma  bacillus  thrives  best  at  temperatures 
between  70  degrees  and  135  degrees  Fahrenheit,  but  is  not  destroyed  and 
only  has  its  growth  checked  by  a  cold  of  IS  degrees  below  the  freezing 
point.  It  is,  however,  readily  killed  by  drying,  by  the  removal  of  all  ani- 
mal material  upon  which  it  can  feed,  or  by  acidifying  the  medium  in  wiiich 
it  is  growing  with  a  mineral  acid.  Under  ordinary  cii'cumstances  the 
bacillus  when  swallowed  is  destroyed  by  the  gastric  juice  being  digested 
in  the  stomach,  but  when  there  is  any  derangement  of  the  stomach,  from 
errors  of  diet  or  any  other  cause,  so  that  the  acid  digestive  liquid  is  de- 
ficient or  absent,  the  bacillus  escapes  destruction,  and  may  pass  on  into 
the  intestine  where  the  fluids  are  alkaline  and  it  is  able  to  develop  with 
great  rapidity.  This  fact  in  regard  to  the  growth  of  the  bacillus  in 
alkaline  fluids  solely  is  one  of  great  importance,  not  only  in  regard  to  the 
treatment  of  cholera,  but  also  in  connection  with  the  subject  of  diet,  since 
it  is  obviously  highly  necessary  to  avoid  everything  which,  by  producing 


330  THE  BEUPTrVB  DISEASES. 

indigestion,  could  interfere  with  the  production  of  the  precious  gastric 
juice. 

Modes  of  Infection — In  cholera  epidemics  we  have,  says  Dr.  Koch, 
instances  amounting  to  actual  experimental  infection  of  man,  as,  for 
examj)le,  in  the  infection  of  those  engaged  in  washing  linen  soiled  with  the 
discharges  from  the  bowels  of  patients  affected  with  cholera.  An  event 
of  this  kind  is  reported  in  the  first  outbreak  of  cholera  in  this  country, 
when  it  was  introduced  into  Quebec  forty-two  years  ago. 

Infection  by  Clothing.— Linen  or  other  clothing  soiled  with  choleraic 
discharges  contains  the  bacilli  often  in  a  pure  form,  and  if  infection  occurs 
through  this  medium  it  must  be  by  the  comma  bacilli,  frequently  the  only 
microscopic  organism  present,  except  those  which  are  known  to  be  inno- 
cent. 

Infection  by  the  Hands. — The  hands  of  a  person  washing  or  handling 
such  clothes  may  be  soiled,  and  the  bacilli  introduced  into  the  mouth  by 
direct  contact,  or  through  the  food  which  thus  becomes  contaminated,  or 
the  washing  water  may  come  in  contact  with  the  lips,  and  thus  in  some 
way  the  human  being  be  fed  with  an  extremely  minute  quantity  of  a  pure 
culture  of  the  comma  bacilhis. 

Infection  by  "Water — "When  Dr.  Koch  was  investigating  the  disease 
in  India  he  observed  an  instance  in  which  a  certain  tank  furnished  the 
water  for  drinking  and  other  purposes  to  many  people  among  whom  the 
cholera  was  raging.  lie  found  the  comma  bacilli  in  this  tank,  and  learned 
on  inquiry  that  the  clothes  of  the  patients  were  washed  in  it.  Around  the 
tank  were  some  thirty  or  forty  huts  inhabited  by  upward  of  two  hundred 
people,  and  of  these  persons  seventeen  died,  whilst  the  number  of  those 
taken  sick  was  not  ascertained.  The  tank  in  this  case  also  received  the 
refuse  from  the  dwellings.  In  fact,  it  is  common  in  India  for  the  Hindoos 
to  bathe  in  the  tank  which  affords  their  water-supply,  to  wash  their  uten- 
sils in  it,  to  deposit  their  excrement  upon  its  bank,  and  if  a  hut  has  a 
latrine,  or  substitute  for  one,  its  outflow  is  apt  to  be  into  the  tank.  In 
this  particular  instance  it  was  found,  after  a  time,  that  the  bacilli  became 
less  abundant  in  the  tank-water,  and  coincidently  the  cholera  declined 
among  the  inhabitants  of  the  huts  along  its  shore.  Here,  if  the  epidemic 
had  been  the  cause  of  the  bacilli,  instead  of  the  result  of  their  develop- 
ment, the  number 'of  these  minute  organisms  ought  to  have  been  aug- 
mented after  the  disease  began  to  be  less  violent.  For  further  dissemina- 
tion of  the  disease,  the  cholera  discharge  must  be  retained  in  a  moist 
state,  since  complete  drying  seems  to  destroy  the  poisonous  property  of 


OHOLEEA.  331 

the  virus;  and  this  view  is  sustained  by  what  we  have  long  known  in 
regard  to  the  spreading  of  cholera  by  contaminated  water-supply,  or  more 
directly  by  soiled  hands,  or  even  conveyance  by  insects,  as,  for  example, 
by  blow-flies  alighting  upon  meat  and  other  food.  Drains  may  be  infected, 
and  through  them  the  drinking  water  polluted;  but  as  the  virus  cannot 
preserve  its  activity  in  a  dry  state  little  can  be  hoped  for  from  aerial  dis- 
infection, nor  does  it  seem  probable  that,  except  imder  certain  conditions 
of  unusual  moisture  can  cholera  be  transmitted  by  r^.erchandise  or  by 
letters,  even  if  the  latter  are  not  disinfected,  but  only  by  human  inter- 
course. 

Symptoms. — Period  of  incubation  ranges  from  two  to  five  days.  The 
symptoms  of  cholera  commonly  present  themselves  sufficiently  gradual  to 
admit  of  arrangement  into  three  distinct  groups  or  stages: 

1.  Preliminary  Diarrhoea — This  may  set  in  abruptly  without  any 
previous  indications.  More  commonly  there  are  for  one  or  two  days 
colicky  pains  in  the  abdomen,  with  looseness  of  the  bowels,  perhaps  vomit- 
ing, with  headache  and  depression  of  spirits.  As  a  rule  the  temperature 
is  not  elevated. 

2.  The  Stage  of  Collapse — Spasmodic  griping  pains  are  felt  and  de- 
pression of  the  powers  of  circulation  and  resjjiration  come  on,  attended 
with  a  sense  of  faintness  and  oppression  over  the  heart,  whose  beat  at 
times  is  hardly  discernible,  and  the  pulse  at  the  wrist  may  be  absent. 
Copious  piirging,  at  first  of  the  contents  of  the  intestines,  and  afterward 
of  a  thin,  watery  fluid,  I'esembling  water  in  which  rice  has  been  washed, 
having  an  alkaline  reaction,  and  sometimes  tinged  red  with  blood,  soon 
commences,  and  is  usually  accompanied  with  violent  vomiting  and  a 
sensation  of  burning  heat  in  the  stomach.  In  a  short  time,  perhaps 
within  a  few  hours,  there  results  from  this  excessive  drain  upon  the  circu- 
lation, coldness  and  dampness  of  the  whole  surface  of  the  body,  lividity 
of  the  lips,  cold  breath,  an  unquenchable  thirst,  a  feeble,  rapid  pulse, 
difficult  respiration,  with  extreme  restlessness,  and  suppression  of  the 
secretion  of  the  kidneys. 

Symptoms  in  Fatal  Cases. — In  fatal  cases  are  noticed  blueness  of  the 
whole  body,  the  sunken  and  horror-stricken  countenance  denominated  the 
Hipprocratic  face,  popularly  known  as  the  appearance  of  being  struck 
with  death,  and  a  peculiarly  suppressed  voice,  this  condition  ending  either 
immediately  in  fatal  collapse  or  in  reaction  followed  by  violent  secondary 
fever. 

3.  Stage  of  Reaction. — This  is  characterized  by  return  of  warmth 


332  ITHE  EKUPTIVK  DISEASES. 

and  colds,  tlie  latter  more  slowly  and  the  re-ostablislunent  of  secretions. 
Especially  favorable  is  the  return  of  the  urinary  secretion.  Along  with 
these  changes  the  vomiting  and  purging  occur  at  longer  intervals.  The 
heart's  action  becomes  stronger,  and  there  are  no  abdominal  pains.  Not 
infre(iucntly  this  favorable  condition  is  interrupted  by  a  recurrence  of  a 
severe  diarrhosa,  and  the  jiatient  is  carried  off  in  a  collapse.  Other  cases 
pass  into  a  condition  of  what  has  been  called  cholera-typhoid,  a  state  in 
which  the  patient  is  delirious,  the  pulse  rapid  and  feeble  and  the  tongue 
dry.  Death  finally  occurs  with  coma.  These  sjmiptoms  have  been  at- 
tributed to  uremia. 

Diagnosis. — The  only  affection  with  which  Asiatic  cholera  could  be 
confounded  is  the  cholera  morbus,  which  occurs  as  a  rule  during  the  sum- 
mer months,  of  which  mention  has  been  made. 

Preventive  Measures — Preventive  measures  are  all-important,  and 
isolation  of  the  sick  with  thorough  disinfection  have  effectually  prevented 
the  disease  from  obtaining  a  foothold  in  either  the  United  States  or  in 
England. 

The  course  of  cholera  during  the  last  epidemic  which  visited  the 
United  States,  and  ravaged  the  Mississippi  Valley  in  1S73,  reafHrmed  the 
lessons  of  previous  outbreaks  of  this  disease  abroad.  This  was  especially 
the  case  as  regards  the  supreme  importance  of  pure  water-supplies  in 
cities  and  villages,  all  of  which  should  be  boiled  before  using,  and  of  hav- 
ing all  wells  and  water-springs  which  are  nsed  by  the  people  effectually 
guarded  against  any  possible  soakage  and  contamination  from  privies  and 
other  sources  of  defilement  by  excrement.  It  must  be  admitted  that  the 
history  of  outbreaks  of  cholera,  in  all  parts  of  tlic  world,  conspicuously 
illustrates  the  vital  importance  of  procuring  all  siipnlies  of  drinking-water 
from  sources  which  cannot  become  polluted  by  the  soakage  into  them  of 
intestinal  discharges,  or  from  outflowings  in  any  such  way  as  to  be  carriers 
of  bowel-diseases,  particularly  not  of  cholera  and  typhoid  fever.  The 
story  of  the  Broad  street  pump  in  London,  Avhich  killed  five  hundred  peo- 
ple in  one  week  during  the  last  gi'eat  cholera  epidemic,  and  was  found  to 
have  its  water  contaminated  by  soakage  of  cholera  evacuations  from  an 
adjoining  cess-pool,  has  already  been  related,  but  it  should  be  retold  to 
every  one  as  a  terrible  warning  against  the  almost  universal  dangers  of 
water-pollution.  An  item  in  the  London  Lancet,  printed  in  1882,  states 
that  a  recent  analysis  of  the  water  of  the  Holy  Well  of  ^lecca,  avhich  is 
so  eagerly  drunk  by  the  pilgrims,  as  a  part  of  their  religious  rites,  shows 
the  water  to  be  sewage,  about  ten  times  stronger  than  the  average  London 


OHOXEBA.  333 

sewage.  And  during  the  same  month  that  this  report  was  given,  came 
the  news  that  the  cholera  had  made  its  usual  annual  appearance  among 
the  pilgrims  to  the  shrine  of  Mahomet  in  the  Holy  City  of  Mecca.  It 
therefore  appears  extremely  probable  that  by  suitable  investigation  of  the 
water  of  the  Holy  Well,  there  might  be  found  in  it  a  perennial  supply  of 
the  cholera  germs,  and  such  a  demonstration  of  the  true  origin  of  the 
frightful  cholera  epidemics  which,  spread  by  the  caravans  of  returning 
Moslem  jiilgrims,  have  so  often  devastated  large  sections  of  Europe  and 
Asia,  would  be  a  triumph  for  experimental  hygiene  of  which  the  whole 
world  of  science  might  bo  proud. 

The  iraj3urity  of  tlie  local  atmosphere  of  a  dwelling,  a  village,  or  a 
particular  district,  is  proved  to  be  a  matter  also  of  piiblic  concern,  and 
environed  in  a  jjoUuted  atmosphere,  the  palatial  mansions  of  wealth  and 
gayety  may  suffer  equally  with  the  tenements  of  the  humblest  classes. 
The  specific  migratory  power  of  cholera,  whatever  its  nature,  has  the 
faculty  of  infecting  districts  in  a  manner  most  detrimental  to  health  only 
when  the  atmosphere  is  fraught  with  certain  jiroducts,  susceptible  under 
its  influence  of  undergoing  poisonous  transformations.  Through  the  un- 
polluted atmosphere  of  cleanly  districts  it  migrates  perhaps  without  a 
blow  because  that  which  it  can  kindle  into  poison  is  not  there. 

Disinfection — 1.  The  vomited  matter  and  the  discharges  from  the 
bowels  are  to  be  gathered  and  put  in  a  carbolic  solution  one  to  twenty,  or 
chlorinated  lime  one  to  ten,  some  of  which  should  be  in  the  vessel  before 
it  is  used.  In  the  country  where  the  excreta  can  be  thrown  in  a  pit, 
"whitewash"  is  a  cheap  disinfectant. 

2.  After  vomiting,  the  mouth  of  the  patient  should  be  rinsed  with  a 
solution  of  hydronapthol  one  to  five  thousand,  care  being  taken  that 
none  of  it  is  swallowed.  After  each  evacuation  from  the  anus  the  but- 
tocks and  thighs  should  be  washed  with  soap  and  water. 

3.  All  body  and  bed  linen  soiled  with  the  discharges  should  be  im- 
mediately moistened  with  a  carbolic  solution  one  to  sixty,  removed  from 
the  ajiartment  in  a  covered  vessel  and  boiled  for  one-half  hour  in  a  one 
per  cent,  solution  of  washing  soda,  or  1  to  2000  of  bichloride  of  mercury. 

4.  Napkins,  towels,  and  so  forth,  should  be  treated  in  like  manner. 

5.  All  dishes,  knives,  forks,  spoons,  and  so  forth,  after  each  meal, 
should  be  boiled  for  the  same  length  of  time  in  the  same  medium. 

G.  The  remains  of  meals  should  be  thrown  in  whitewash  and  removed 
at  the  end  of  each  day. 


334  THE  EETJPTIVE  DISEASES. 

7.  Door  knobs  are  liable  to  be  soiled  by  the  bands  of  one  carrying 
out  the  excreta  and  should  be  carefully  watched. 

8.  In  cases  of  death  the  body,  without  being  washed,  should  be 
wrapped  in  sheets  wet  in  a  solution  of  bichloride  of  mercnry  and  should 
be  buried  promptly. 

Directions  for  Nurses. — 1.  Xurses  should  not  hold  any  direct  com- 
munication with  others  while  in  attendance  on  the  case. 

2.  They  should  under  no  conditions  take  their  meals  in  the  same 
room  with  the  patient.  After  touching  the  patient  her  hands  should  be 
washed  in  bichloride  of  mercury  one  to  one  thousand. 

3.  The  teeth  should  be  cleansed  after  each  meal,  as  the  mouth  affords 
a  peculiar  favorable  nidus  for  decomposing  matter  and  would  therefore 
be  favorable  for  the  growth  of  the  cholera  bacillus. 

Treatment — The  successful  treatment  of  cholera  depends  largely 
upon  how  i^romptly  remedial  measures  are  commenced,  for  if  the  first 
sign  of  relaxation  of  the  bowels  is  met  at  once  by  an  energetic  astringent 
and  opiate,  such  as  the  mixture  of  a  teaspoonful  of  syrup  of  galls,  ten  drops 
of  laudanum,  and  one  drop  of  chloroform,  repeated  every  hour  if  neces- 
sary, or  a  compoimd  of  ten  drops  each  of  spirits  of  camphor,  tincture  of 
capsicum  and  laudanum,  to  which,  if  there  is  any  vomiting,  five  grains  of 
bismuth  should  be  added,  it  is  certain  that  many  lives  might  be  directly 
saved  by  medical  treatment.  External  applications  of  heat  should  be 
made,  warm  applications  to  the  abdomen  will  be  foimd  grateful  to  the 
patient.  Sometimes  a  pill  of  opium  and  acetate  of  lead,  with  a  little 
capsicum,  using,  for  example,  one-half  of  a  grain  of  opixun,  two  gr-ains  of 
the  sugar  of  lead,  and  a  quarter  of  a  grain  of  cayenne  pepper,  is  singularly 
sei-viceable,  and  being  carried  in  small  compass  is  especially  convenient 
for  travelers. 

Pain  Treatment. — Should  the  pain  be  great  control  it  with  one-fourth 
grain  injections  of  morphine  hypodermically.  As  owing  to  the  profuse 
discharges  the  blood  is  very  much  concentrated,  subcutaneous  injections  of 
normal  salt  solution  should  be  given. 

The  following  well-known  cholera  or  diarrhoea  mixture  is  of  great 
value  in  the  early  stages: 

Spirits   of    camphor    „ i       " 

Tincture  capsicum I        " 

Pure  chloroform    3  drachms 

Alcohol  sufficient  to  make  5  ounces. 

Mix  and  take  one  teaspoonful  every  one  or  two  hours. 


DIPHTHERIA.  335 

DIPHTHERIA. 

Definition. — An  acute  infectious  disease  clue  to  Klebs-Loefler  bacillus, 
characterized  by  a  local  fibrinous  exudate  usually  upon  the  mucous  mem- 
brane of  the  throat,  with  a  moderate  fever,  glandular  enlargements  and 
great  iirostration. 

Cause. — The  disease  is  endemic  in  all  large  cities,  and  becomes 
epidemic  at  times ;  while  other  contagious  diseases  have  diminished  in  the 
past  decade,   diphtheria  has  increased,   particularly  in  cities. 

Contagiousness — Diphtheria  is  a  highly  contagious  disease,  and  is 
readily  transmitted  from  person  to  person.  The  bacilli  may  be  received 
from  (1)  discharges  of  diphtheria  patients,  (2)  from  the  secretions  of  the 
nose  and  throat  of  convalescent  cases,  in  which  the  virulent  bacilli  per- 
sists, (3)  from  the  throats  of  healthy  individuals  who  have  acquired  the 
bacilli  from  being  in  contact  with  others  having  the  virulent  bacilli  on 
their  persons  or  clothing. 

Dangers  of  the  Disease — ISTo  disease  of  temperate  regions  proves  more 
fatal  to  physicians  and  nurses.  There  seems  to  be  particular  danger  in 
examining  and  swabbing  out  the  throat;  for  in  the  gagging,  spluttering 
and  coughing  efforts  the  patient  may  cough  mucus  and  flakes  of  mem- 
brane into  the  physician's  throat.  The  bacillus  attaches  itself  to  the 
bedding,  clothes  and  room  of  the  patient  with  great  tenacity. 

Attack  Upon  Children — Very  young  children  are  rarely  attacked,  the 
age  of  predilection  being  from  the  second  to  the  fifteenth  year.  The  great- 
est number  of  deaths  occur  between  two  and  five  years  of  age.  Girls  are 
attacked  in  larger  numbers  than  boys.     Adults  are  frequently  affected. 

Symptoms — Period  of  incubation  is  from  two  to  seven  days;  oftener 
two  (Tyson). 

According  to  the  location  we  may  speak  of  the  pharyngeal,  laryngeal 
and  nasal  varieties. 

1.  Pharjmgeal. — The  symptoms  are  those  of  an  ordinary  febrile  at- 
tack. Slight  chilliness,  fever  and  aching  pains  in  the  back  and  limbs, 
usually  the  temperature  rises  in  the  first  twenty-four  hours  from  102 
to  103  degrees  Fahrenheit.  There  is  a  slight  redness  and  feeling  of  sore- 
ness in  the  throat,  generally  upon  one  or  both  tonsils,  and  on  careful  exam- 
ination the  tonsils  and  adjacent  portions  of  the  fauces  are  found  to  be  a 
little  swelled.  A  whitish-gray  patch  of  false  membrane,  looking  at  first 
like  a  small  ulcer  in  the  mucous  surface,  next  makes  its  appearance,  and 
this  may  spread  until,  by  the  third  day,  it  has  covered  the  tonsils,  fauces 
and  perhaps  the  uvula. 


336  TUE  KRDPTIVE  DISEASES. 

The  False  Membrane. — If  this  false  membrane  is  forcibly  torn  away, 
as,  fiu'  oxainple,  by  some  of  the  various  forecps  which  were  at  tirst  invented 
for  the  pnrj)ose,  a  raw  bleeding  surface  is  exposed,  which  in  a  few  hours 
is  again  covered  with  a  new  growth  of  the  layer  of  membrane.  This 
structure,  which  is  partly  composed  of  an  exudation  of  lymph  and  partly 
of  a  fungoid  growth,  the  micrococcus  diphtheriticus,  quickly  undergoes 
putrefactive  changes,  together  with  the  outer  layer  of  mucous  membrane 
lying  immediately  beneath  it,  so  that  there  is  often  a  superficial  ulcera- 
tion, from  which  an  unhealthy  discharge  flows,  and  a  jsutrid  odor  fre- 
quently emanates  constantly,  in  sevore  cases  of  diphtheria. 

Thickness  of  the  Membrane. — The  thickness  and  density  of  the  false 
membrane  varies  greatly  in  different  cases,  and  in  different  epidemics. 
Sometimes  it  is  scarcely  thicker  than  writing-paper,  and  has  hardly  more 
consistence  than  thick  cream.  At  other  times  it  is  firm  and  tough,  almost 
like  leather,  and  may  even  attain  the  thickness  of  a  quarter  of  an  inch. 
Although  in  mild  cases  and  those  of  moderate  severity,  its  color  is  grayish- 
white,  in  debilitated  states  of  the  system,  and  when  there  is  a  tendency 
to  bleeding  from  the  throat  and  other  mucous  surfaces,  it  may  be  tinged, 
I)robab]y  by  the  altered  blood  elements  of  a  yellow,  yellowish-brown,  or 
dark-brtiwn  hue. 

Diagnosis (a)    There  may  be  no  local  manifestation  of  the  mem- 

bi-ane,  but  a  simple  catarrhal  angina,  associated  sometimes  with  a  croupy 
cough.  The  detection  iu  these  cases  of  the  Klebs-Loefler  bacillus  can 
alone  determine  the  diagnosis. 

(h)  There  are  cases  in  which  the  tonsils  are  covered  with  a  pulta- 
ceous  exudate,  not  a  consistent  membrane. 

(c)  Cases  which  begin  and  often  run  their  entire  course  with  the 
local  picture  of  a  typical  lacunar  amygdalitis,  they  may  be  mild,  but  in 
other  cases  there  is  a  rapid  development  of  membrane  and  extension  of 
the  disease  to  the  pharynx  and  nose  with  septic  and  constitutional 
symptoms. 

2.  Nasal  Diphtheria — In  membranous  or  fibrinous  rhinitis,  a  very 
remarkable  affection  seen  usually  in  children,  the  nares  are  occupied  by 
thick  membranes,  but  there  is  entire  absence  of  constitutional  disturb- 
ances. Ravenel  collected  seventy-seven  cases,  all  of  which  ran  a  benign 
course,  and  in  all  but  a  few  the  membrane  was  limited  to  the  nose  and  the 
constitutional  symptoms  were  slight  or  absent.  On  the  other  hand,  nasal 
diphtheria  is  apt  to  present  a  most  malignant  type  of  the  disease,  high 


DIPHTHEEIA.  337 

fever,  marked  glandular  evolvement  and  great  prostration  by  epistaxis 
and  by  excoriation  of  tbe  lips. 

3.  Laryngeal  Diphtheria — The  affection  begins  like  an  acute  laryn- 
gitis, wiLh  a  slight  hoarseness  and  rough  cough,  to  which  the  term  croupy 
has  been  applied.  After  these  symptoms  have  lasted  a  day  or  two,  with 
varying  intensity,  the  child  suddenly  becomes  worse,  usually  at  night,  and 
there  are  signs  of  impeded  respiration.     These  cases  are  always  serious. 

Difficulty  of  Breathing — ^At  first  tbe  difficulty  in  breathing  is  paroxys- 
mal, owing  probably  to  a  spasm  of  the  muscles  of  the  glottis.  Soon  the 
dyspncea  becomes  continuous,  inspiration  and  expiration  become  difficult, 
particularly  the  latter.  The  voice  is  husky  and  is  reduced  to  a  whisper. 
The  color  gradually  changes  and  the  imperfect  aeration  of  the  blood  is 
shown  in  the  lividity  of  the  lips  and  finger  tips.  Restlessness  comes  on 
and  the  child  tosses  from  side  to  side,  vainly  trying  to  get  breath.  Oc- 
casionally in  severer  paroxysms  portions  of  the  membrane  are  coughed  up. 

The  Fever. — The  fever  is  rarely  very  high,  and  the  condition  of  the 
child  at  the  onset  is  good.  The  pulse  is  always  increased  in  frequency. 
In  favorable  cases  the  dyspnoea  is  not  very  urgent,  and  the  color  of  the 
face  remains  good.  In  unfavorable  cases  the  dyspna?a  becomes  more  and 
more  urgent,  the  cyanosis  deepens,  and  the  child,  after  a  period  of  rest- 
lessness, sinks  into  a  semi-comatose  state,  and  death  finally  occurs  from 
poisoning  of  the  nerve  centres  by  carbon  dioxide. 

1.  Complications. — Hemorrhages  from  the  nose  or  throat  may  occur 
in  severe  ulcerative  cases.  Skin  rashes  are  not  infrequent.  In  very  bad 
cases,  with  extensive  sloughing,  the  septic  particles  may  reach  the  bronchi 
and  excite  gangrenous  processes,  which  may  lead  to  severe  and  fatal 
hemorrhages. 

2.  Renal  Complications. — These  are  common,  albuminiira  is  present 
in  all  severe  cases;  nephritis  may  set  in  quite  early  in  the  disease;  it  sets 
in  at  times  with  complete  suppression  of  the  urine. 

3.  Paralysis. — Tliis  is  rather  frequent,  occurring  in  from  ten  to  even 
twenty  per  cent,  of  cases. 

Diagnosis — The  onset  is  more  sudden  than  in  scarlet  fever,  the  fever 
higher,  the  pulse  more  rapid  and  the  tongue  presents  a  strawberry  appear- 
ance. For  the  rest  of  the  diseases  it  is  sufficient  to  state  that,  for  the 
purpose  of  insuring  proper  sanitary  precautions,  it  is  advisable  to  con- 
sider all  cases  of  sore  throat,  with  fever  and  prostration  of  strength,  in 
which  patches  of  false  membrane,  however  small,  appear  upon  the  tonsils 
22 


338  THE  EEtrPTIVE  DISEASES. 

or  fauces,  as  diphtheritic  in  their  character.     All  cases  should  be  treated 
as  di{)htlieria  imtil  the  contrary  is  proven  by  a  culture. 

Preventive  Measures — Recent  investigations  having  proved  that  the 
poison  of  diphtheria  is  ^Jortable,  communicable  by  infection,  and  capable 
of  reproducing  itself  outside  of  the  hiunan  body,  diphtheria  must  now  be 
ranked  as  both  a  contagious  and  infectious  disease.  The  following  rules 
are  therefore  more  imperative  than  ever  before : 

1.  When  a  child  or  young  person  has  a  sore  throat,  a  bad  odor  to  its 
breath,  and  especially  if  it  has  fever,  it  should  immediately  be  separated 
and  kept  secluded  from  all  other  persons,  except  necessary  attendants, 
until  it  be  ascertained  whether  or  not  it  has  diphtheria,  or  some  other 
communicable  disease. 

2.  Every  person  known  to  be  sick  with  diphtheria  should  be  promptly 
and  effectually  isolated  from  the  public.  Only  those  persons  who  are  act- 
ually necessary  should  have  charge  of  or  visit  the  patient,  and  these  visi- 
tors should  be  restricted  in  their  intercourse  with  other  individuals. 
Children  residing  in  a  house  where  there  is  a  case  of  diphtheria  should 
not  be  permitted  to  attend  school. 

3.  When  a  case  of  diphtheria  is  fully  developed,  the  same  precautions 
in  regard  to  free  ventilation,  disposal  and  disinfection  of  discharges,  bed 
or  body  linen,  and  so  forth,  isolation  during  convalescence  (or  manage- 
ment of  the  corpse  should  death  unfortunately  occur),  and  so  forth,  ought 
to  be  enforced  which  have  already  been  recommended  in  regard  to  small- 
pox and  cholera. 

4.  It  is  particularly  important  that  persons  whose  throats  are  tender 
or  sore  from  any  cause,  should  avoid  possible  exposure  to  the  contagion  of 
diphtheria.  Children  imder  ten  years  of  age  are  in  much  greater  danger 
of  taking  the  disease,  and  after  they  do  take  it  of  dying  from  it,  than  are 
grown  persons.  But  adults  are  not  exempt,  and  mild  cases  in  them  may 
cause  whole  series  of  fatal  attacks  among  children. 

5.  IN^umerous  instances  are  recorded  where  the  contagion  of  diph- 
theria has  retained  its  virulence  for  weeks  or  months,  in  cesspools,  heaps 
of  decaying  vegetable  matter,  damp  walls,  and  so  forth,  and  been  carried 
for  long  distances  in  clothing,  in  sewers,  in  waste  pipes  from  stationary 
washstands,  and  in  other  conduits.  Hence  all  sewer  connections  and  other 
carriers  of  filth  should  be  well  ventilated  and  disinfected,  and  children 
particularly  should  not  be  allowed  to  breathe  the  air  of  any  water-closet, 
cesspool,  or  sewer  into  which  discharges  from  patients  sick  with  diphtheria 


DIPHTHEEIA.  339, 

have  entered,  nor  drink  water  or  milk  wbiek  has  been  exposed  to  suck 
air  or  tke  atmosphere  of  the  sick-room. 

6.  Beware  of  any  person  who  has  a  sore  throat;  do  not  kiss  such 
a  person  or  take  his  or  her  breath ;  do  not  drink  from  the  same  cup,  blow 
the  same  whistle,  nor  put  his  pencil  or  pen  into  your  mouth. 

2.  Treatment — Local  treatment — ^germicides  and  disinfectants  are 
best  applied  when  possible  by  the  spraying  apparatus  at  intervals  of  an 
hour,  or  at  most  every  two  hours.  If  the  spray  cannot  be  used,  as  is 
often  the  case  with  children,  a  soft  sponge  may  be  used.  The  most  satis- 
factory solution  for  this  purpose  is  equal  parts  of  peroxide  of  hydrogen 
and  Dobell's  solution.  Carbolic  acid  may  be  used  in  the  proijortion  of 
fifteen  drojjs  to  an  ounce  of  glycerine  and  water.  Boric  acid  in  saturated 
solution  is  fairly  good.  Where  there  is  the  laryngeal  form  the  patient 
should  breathe  an  atmosphere  saturated  with  the  vapor  of  slacked  lime. 
In  all  cases  antitoxin  should  be  given. 

2.  Constitutional  Treatment. — For  checking  the  growth  of  the  mem- 
brane the  preparations  of  mercury  are  good.  The  bichloride  of  mercury 
in  dose  of  one-forty-eighth  to  one-twelfth  (Tyson)  for  an  adult,  in  con- 
junction with  the  tincture  of  the  chloride  of  iron  and  chlorate  of  potas- 
sium every  two  hours.  Early  in  the  cases  calomel  in  small  doses  every 
hour.  These  doses  are  given  to  adults,  and  they  need  not  be  much  re- 
duced for  children.  Quinine  should  form  part  of  the  medical  treatment 
in  doses  from  ten  to  twenty-four  grains  in  twenty-four  hours. 

Other  prescriptions  are: 
1. 

Bichloride  of  Mercury 1  grain 

Tincture  Chloride  of  Iron 1  ounce 

Two  to  six  drops  every  three  hours  in  water. 

2. 

Chloride  of  Potash 1  drachm 

Tincture  Chloride  of  Iron IM;  drachms 

Syrup  of  Lemon 1  ounce 

Spirits  of  Mindererus 4  ounces 

Mix.     Dose:  one  teaspoonful  every  two  hovirs. 

If  this  prescription  cannot  readily  be  filled  a  fairly  good  substitute 
is  the  Tincture  of  Chloride  of  Iron.  Get  about  one  ounce  of  this  and  take 
ten  drops  in  a  wineglassful  of  water  three  times  a  day.     This  is  a  valu- 


340  THE  ERUPTIVE  DISEASKf,. 

al)lo   tonic,  but   if  there  is  iiuicli   fiiiliirc   of  strpnwtli,    use   the   followiuir 
in  udditiou  to  tlie  ohloritle  of  iron: 

3. 

Siilpliate  Quinine  (Powder)    1  drachm 

Best  Brandy 1  pint 

Mix  and  dissolve.  Dose:  two  teaspoonfuls  every  three  hours  in  half 
a  glass  of  water. 

Diet. — Stimulating,  nourishing  and  easily  assimilated  food  is  neces- 
sary. Milk  is  preferred  to  all  else,  fortified  with  full  doses  of  whiskey, 
two  drachms  to  an  ounce  being  required  in  all  severe  cases.  Milk  may 
be  alternated  with,  animal  broths.  When  deghitition  is  difficult  nutrient 
enematas  may  bo  given.     For  this  peptonized  milk  is  best. 

Opening  the  Windpipe. — When  laryngeal  obstruction  is  imminent 
intubation  or  tracheotomy  should  be  performed.  This  is  rarely  necessary 
when  antitoxin  is  used.  Lives  have  been  saved  by  both  these  operations. 
Such  cases  sliould  breathe  air  charged  with  vapor  of  lime. 

3.  Serum  Treatment — It  has  been  fully  demonstrated  that  antitoxin 
or  the  scrum  of  immunized  animals,  is  the  best  therapeutic  agent  in 
diphtheria.  Tlie  investigation  conducted  by  the  American  Pediatric 
Society  has  show^l  that  the  mortality  under  the  serum  treatment  in  5,79-4 
cases  was  only  12.3  per  cent.  The  strength  of  the  serum  is  measured  in 
units,  the  latter  being  equal  to  1  c.cra.  of  "normal  serum,"  which  is  the 
blood  serum  of  an  immunized  animal  so  active  that  one-tenth  of  a  c.cm. 
will  antagonize  ten  times  the  minimum  of  dijihtheria  poison  fatal  to  a 
guinea  pig  weighing  300  grams.  For  children  over  two  years  old  the 
initial  dose  should  be  from  1,500  to  2,000  units  in  all  severe  cases,  in- 
cluding those  of  laryngeal  stenosis ;  this  dose  to  be  repeated  in  from 
eighteen  to  twenty-four  liours  if  there  is  no  improvement  seen,  and  again 
in  twenty-four  hours  if  the  course  of  the  disease  is  imfavorable.  The 
third  dose  is  rarely  necessary.  ]\lild  cases  should  receive  1,000  units  for 
the  first  injection,  a  second  is  rarely  necessary.  In  cases  injected  during 
the  first  two  days  the  mortality  is  less  than  5  per  cent.  The  qiiestion  of 
immunizing  those  exposed  to  the  disease  is  a  very  practical  one.  It  has 
been  carried  out  on  a  very  large  scale  in  some  institutions  with  satisfactory 
results.     The  immunity  is  only  transient  and  only  persists  a  few  weeks. 

Diphtheria  antitoxin  is  injected  beneath  the  skin  and  is  not  a  pain- 
ful procedure  and  rarely  has  ill-effects  if  properly  given  and  the  pre- 
cautions of  cleanliness  are  followed  as  to  the  skin  of  the  patient,   the 


DIPHTHEEIA.  341 

needle  used  and  hands  o£  the  nurse  and  physician.  Every  adult  case 
should  receive  a  dose  of  antitoxin  of  3,000  units  immediately  ui^on  the 
jihysician  heing  sure  that  the  patient  has  di^jhtheria.  In  severe  cases 
as  high  as  20,000  or  more  units  have  been  given  in  repeated  doses  with- 
out ill  effects  and  the  child  has  recovered.  Those  in  attendance,  as 
nurses,  physicians  and  all  persons  who  have  come  in  contact  with  the 
patient,  must  receive  at  least  500  units  as  a  preventive  measure  against 
taking  the  disease. 

Those  who  cannot  afford  to  jiurchase  antitoxin  can  secure  it  from 
the  authorities  of  the  local  Boards  of  Health  iu  most  States.  In  large 
cities  it  can  ho  procured  from  the  police  stations. 

Every  parent  or  guardian  should  submit  to  the  early  use  of  anti- 
toxin and  thereby  save  human  life.  Those  exposed  to  it  should  also  sub- 
mit and  protect  themselves  and  prevent  the  spread  of  this  highly  dan- 
gerous and  contagious  disease.  Public  funerals  cannot  be  held  in  case 
of  death  from  diphtheria.  Cremation  oi"  burial  in  a  sealed  casket  is 
necessary. 

General  Remarks.- — Diphtheria  is  a  highly  contagious  disease,  occur- 
ring mostly  iu  children  between  the  ages  of  two  and  fifteen  years.  In- 
fants in  the  first  year  of  life  are  rarely  affected.  Death  is  most  frequent 
between  children  of  two  to  five  years  of  age.  It  occurs  mostly  during  the 
winter.  It  can  be  caught  by  persons  of  all  walks  of  life  by  coming  in 
contact  with  a  patient  or  his  or  her  clothing,  bed  linen,  etc.,  which  has 
not  been  disinfected.  It  can  be  carried  in  water,  milk,  by  the  dried 
discharges  from  the  patient's  nose  and  throat,  being  blown  about  in  the 
air,  dirty  streets,  gutters,  alleys,  cesspools,  etc. 

It  requires  from  two  to  seven  days  for  a  person  to  develop  diphtheria 
after  being  exposed  to  it.  Its  early  symptoms  consist  of  slight  chilliness, 
in  young  children  con\'ulsions,  older  children  and  adults  complain  of  a 
sore  throat.  There  may  be  vomiting.  Examine  the  throat  at  once.  The 
tonsils  and  arches  of  the  soft  palate  appear  reddened,  swollen  and  a  whit- 
ish membrane  in  spots  or  as  a  solid  layer  will  be  seen  covering  the  tonsils 
and  later  on  this  spreads  to  the  nose,  throat,  larynx,  etc.,  depending  on 
the  severity  of  the  attack.  The  child  will  complain  of  a  tightness  in  the 
throat,  pain  or  swelling  and  if  the  attack  is  sudden  and  severe,  the  face 
and  lips  become  bluish  and  breathing  is  difiieult,  and  there  may  be  a 
whisfling  sound  upon  taking  each  breath,  due  to  the  membrane  filling  the 
larynx  and  throat.     The  germs  of  this  disease  are  present  in  the  nose  and 


342  THE  EBUPTIVE  DISEASES. 

throat  of  the  patient.  Summon  a  physician  at  once.  The  guardian  or 
physician  must  notify  the  local  Board  of  Health. 

The  sick  person  must  be  placed,  whenever  possible,  in  a  room  away 
from  the  rest  of  the  family,  all  imnecessary  furnishing  removed,  a  nurse 
or  attendant  placed  in  charge  and  no  one  permitted  to  enter  or  leave 
the  room  but  the  nurse  and  physician  imtil  disinfection  is  completed  by 
the  Board  of  Health.  Cats,  dogs  and  all  the  family  pets  must  be  removed 
from  the  room  and  quarantined  outside  of  the  house.  The  physician 
should  wear  a  cotton  gown  and  cover  his  head  with  a  cloth  of  suitable 
texture.  The  nurse  must  wear  a  similar  gown  and  cover  the  hair  with  a 
cloth.  On  leaving  the  room,  the  physician  and  nurse  must  leave  the 
head  covering  and  gown  in  the  room,  also  disinfect  their  hands  in  a 
disinfectant  of  5  per  cent,  carbolic  acid  solution  or  bichloride  of  mercury 
(1  tablet  to  a  pint  of  water). 

Persons  living  in  a  house  where  diphtheria  has  developed  should  not 
leave  until  they  have  taken  a  bath  in  water  containing  bichloride  of  mer- 
cury, washed  their  hair  and  had  their  clothing  disinfected  by  the  Bureau 
of  Health.  A  sheet  must  be  hung  across  the  door  leading  to  the  sick 
room  and  this  sheet  dipped  in  and  kept  moist  by  a  solution  of  chloride 
of  lime  (1  tablespoonful  to  a  i^ail  of  cold  water).  The  knob  of  the  door 
should  be  washed  off  daily  with  the  chloride  of  lime  solution. 

INTITJENZA  OR  LA  GRIPPE. 

Definition — An  acute  infectious  disease,  appearing  at  irregular  inter- 
vals, characterized  by  extraordinary  rapidity  of  extension  and  the  large 
number  of  people  attacked. 

Causes. — It  is  caused  by  the  bacillus  of  Pfeiffer.  It  spreads  with 
remarkable  rapidity.  In  the  large  pandemic  of  1889-1890  some  of  the 
large  prisons  escaped  entirely.  The  outbreaks  of  the  epidemics  are  in- 
dependent of  all  seasons  and  meteorological  conditions,  though  the  worst 
epidemics  have  been  in  the  colder  seasons  of  the  year.  One  attack  does 
not  protect.    A  few  persons  do  not  appear  liable  to  the  disease. 

Symptoms — Incubation  is  from  one  to  four  days.  The  onset  is  usu- 
ally abrupt,  with  fever  and  its  associated  phenomena.  Usually  there  is 
coryza  and  sneezing,  with  or  without  watering  of  the  eyes  and  headache. 
No  age  is  exempt,  as  it  attacks  with  impunity  the  infant  as  well  as  the 
old  man.  There  is  generally  a  cough,  to  which  is  added  very  soon  profuse 
expectorations. 


OLAlirDEES  OE  FAEOT.  343 

Expectorations — The  cough  may  be  paroxysmal,  with  prostration  at 
the  end  of  the  spell.  It  often  persists,  while  the  bronchitis  may  pass  into 
broncho-pneumonia,  or  a  croupous-pneumonia  may  supervene.  Another 
mode  of  onset  is  by  extreme  and  sudden  jjrostration.  This  prostration  is 
apt  to  be  prolonged  even  in  mild  eases  far  beyond  what  seems  reasonable. 

Mental  Depression. — This  is  a  frequent  symptom,  and  suicide  has  been 
its  terminal  act.  There  is  always  more  or  less  fever,  ranging  from  101 
degrees  to  lOG  degrees  Fahrenheit.  Delirium  is  nearly  always  associated 
with  a  high  fever. 

Nausea  and  Vomiting — ^With  the  onset  of  the  fever  there  may  be 
nausea  and  vomiting,  or  the  attack  may  set  in  with  abdominal  pains,  pro- 
fuse diarrhcea  and  collapse. 

Diagnosis — During  a  pandemic  the  cases  offer  but  slight  difficulty. 
The  profoundness  of  the  prostration,  out  of  all  proportion  to  intensity  of 
the  disease,  is  one  of  the  most  characteristic  features. 

Treatment. — Isolation  should  be  practiced  if  possible.  Old  people 
should  be  guarded  against  all  sources  of  infection.  The  secretions,  nasal 
and  bronchal,  should  be  disinfected.  In  every  case  the  disease  should  be 
regarded  as  serious  and  the  patient  kept  in  bed  until  the  fever  has  com- 
pletely disappeared.  From  the  onset  the  treatment  should  be  supporting, 
and  the  patient  should  be  well  fed  and  nursed.  At  night  ten  grains  of 
Dover's  powder  niay  be  given.  At  the  onset  a  warm  bath  is  sometimes 
grateful  in  relieving  the  pains  in  the  back  and  limbs.  If  there  is  much 
fever  and  delirium  small  doses  of  antipyrin  or  phenacetin  may  be  given 
and  an  ice-cap  applied  to  the  head.  In  cases  with  great  cardiac  weakness 
stimulants  should  be  given  freely  and  during  convalescence.  Strychnia 
in  full  doses  and  good,  nutritious  diet,  cheerful  surroundings  and  change 
of  air  are  essential.  The  depression  of  spirits  following  this  disease  is 
one  of  its  most  unpleasant  and  obstinate  features. 

GIANDERS  OR  FARCY. 

Definition. — ^An  acute  infectious  disease,  usually  commencing  with  a 
specific  inflammation  of  the  mucous  membranes  of  the  nose  and  throat,  and 
Originating  in  contagion  derived  from  a  glandered  horse,  ass  or  mule,  and 
characterized  by  the  aj^peamce  of  vesicles  in  the  mucous  membrane  of 
the  mouth  and  between  the  toes  and  nodules  beneath  the  skin ;  in  the  latter 
it  is  called  farcy. 

Cause. — The  disease  belongs  to  the  infective  granulomata.     The  local 


344  THE  KUUmVE  DISEASES. 

manifestations  in  the  nostrils  and  skin  of  the  horse  are  due  to  one  and 
the  same  cause.  Man  becomes  infected  by  contact  with  diseased  animals, 
and  iisually  bj  inoculation  on  an  abraded  surface  of  the  skin.  The  con- 
tagion may  also  be  received  on  the  mucous  membrane. 

Symptoms — The  disease  has  an  incubation  of  from  three  to  five  days. 
At  this  time  there  is  a  febrile  movement,  with  malaise  and  loss  of  appetite. 
On  the  mucous  membrane  of  the  lips  and  tongue  and  sometimes  on  the 
hard  palate  come  vesicles  containing  a  yellowish  serum.  There  is  a 
sensation  of  heat  and  burning  through  the  mouth,  and  the  swelling  may 
be  so  great  as  to  make  speech  difJicidt  and  swallowing  painful.  There  is 
copious  salivation.  Almost  simultaneously  appear  vesicles  between  the 
fingers  and  toes  and  around  the  nails. 

Treatment — If  seen  early  the  wound  shoidd  be  either  cut  out  or 
thoroughly  destroyed  by  caustics  and  an  antiseptic  dressing  apjjlied.  In 
the  acute  cases  there  is  very  little  hope.  In  chronic  cases  recovery  is 
possible,  though  often  tedious. 

ANTHRAX  OR  MALIGNANT  PUSTULE. 

Definition — An  acute  infectious  disease  of  animals,  due  to  the  bacillus 
anthracis,  especially  affecting  cattle  and  sheep,  but  transmissible  to  man. 

Causes. — It  is  very  prevalent  in  Europe  and  Asia,  but  is  rare  in  this 
country.  A  protective  inoculation,  with  a  mitigating  virus,  has  been  in- 
troduced by  Pasteur.  In  animals  the  disease  is  conveyed  sometimes  by 
direct  inoculation,  as  by  the  bites  and  stings  of  insects,  by  feeding  on  the 
carcasses  of  animals  which  have  died  of  the  disease,  but  more  commonly  by 
feeding  in  jiastures  in  which  the  germs  have  been  preserved.  Pasteur 
believes  that  the  earth  worm  plays  an  important  part  in  bringing  to  the 
surface  and  distributing  the  bacilli  which  have  lieen  propagated  in  the 
buried  carcass  of  an  infected  animal.  Certain  fields  or  even  farms  may 
thus  be  infected  for  an  indefinite  period  of  time. 

Symptoms — Anthrax  has  a  period  of  incubation  of  about  one  week, 
after  which  there  are  a  number  of  modes  of  manifestation  of  the  disease. 

1.  External  Anthrax  or  Malignant  Pustule This  occurs  most  fre- 
quently on  the  exposed  stirfaces,  the  arms,  face  or  hands,  and  produces 
in  a  few  hours  a  slight  i-edness  like  that  from  a  mosquito  bite,  and  after- 
ward a  little  blister.  This  is  soon  succeeded  by  a  spreading  hardness  of 
the  surrounding  tissues,  which  mortify  and  turn  black.  Crops  of  sec- 
ondary vesicles   appear,   the   neighboring  lymphatic  glands   become  in- 


MALIGNANT   PUSTULE.  345 

flamed,  the  breath  grows  fetid,  and  there  is  thirst,  high  temperature  and 
frequent  pulse,  and  death  may  take  place  in  from  twelve  to  forty-eight 
hours,  with  all  the  symptoms  of  profound  blood-poisoning.  Occasionally 
recovery  takes  place,  but  it  is  only  in  mild  cases,  in  which  all  the  symp- 
toms, local  and  general,  are  less  severe ;  the  vesicles  dry  up  into  scabs  and 
the  hardness  passes  away. 

2.  Malignant  Anthrax,  Edema — This  form  begins  in  the  eyelid,  and 
from  thence  passes  into  the  head,  arms  and  hands.  It  is  characterized  by 
the  absence  of  the  vesicles  and  by  the  most  extensive  oedema,  which  may 
follow,  rather  than  precede,  the  constitutional  symptoms.  The  most  fatal 
cases  are  seen  when  inoculation  takes  place  about  the  head  and  face.  A 
feature  in  both  these  forms  of  malignant  pustule,  to  which  many  writers 
refer,  is  the  absence  of  feelings  of  distress  or  anxiety  on  the  part  of  the 
patient,  whose  mental  condition  may  be  perfectly  clear.  He  may  be  with- 
out apprehension,  even  though  his  condition  is  very  critical. 

Diagnosis — Diagnosis  can  be  readily  made  from  the  character  of  the 
lesion  and  the  occupation  of  the  patient.  When  in  doubt  a  microscopical 
examination  of  the  fluid  from  the  pustule  may  show  the  presence  of  the 
bacillus. 

3.  Intestinal  Form — In  these  cases  the  infection  is  usually  through 
the  stomach  and  intestines  and  results  from  eating  the  flesh  or  drinking 
the  milk  of  diseased  animals.  It  may,  however,  follow  an  external  in- 
fection if  the  germs  are  carried  to  the  mouth.  In  acute  cases  there  are 
dyspnoea,  cyanosis,  great  anxiety  and  restlessness,  and  toward  the  end  con- 
vulsions or  spasms  of  the  muscles. 

4.  Wool  Sorters'  Disease — This  Important  form  of  anthrax  is  found 
in  large  establishments  in  which  wool  or  hair  is  sorted  and  cleansed.  The 
hair  and  wool  Imported  into  Europe  from  Eussia  and  South  America  ap- 
pear to  have  Induced  the  largest  number  of  cases.  Many  of  these  show 
no  external  lesion.  The  Infected  material  being  swallowed  or  Inhaled 
with  the  dust. 

Symptoms There  are  rarely  any  preliminary  symptoms.  The  pa- 
tient is  seized  with  a  chill,  becomes  faint  and  prostrated,  has  pains  in  the 
back  and  legs  and  the  temperature  rises  to  102  degrees  or  103  degrees 
Fahrenheit.  The  breathing  is  rapid,  and  there  is  much  pain  in  the  chest. 
There  may  be  a  cough  and  signs  of  bronchitis.  There  may  be  vomiting, 
and  death  may  occur  within  twenty-four  hours.  In  more  protracted 
cases  there  may  be  diarrhoea,  delirium  and  unconsciousness. 

Treatment. — In  malignant  pustule,   the  site  of  inoculation  should 


346  ITHl}  EETJPTIVB  DISEASES. 

he  destroyed  by  the  caustic  or  hot  iron  and  a  little  powdered  bichloride  of 
mercury  sprinkled  over  the  exposed  surface.  The  local  development  of 
the  bacilli  about  the  site  of  inoculation  may  be  prevented  by  the  sub- 
cutaneous injections  of  carbolic  acid  or  bichloride  of  mercury.  The  in- 
jections should  be  made  at  various  2>oints  around  the  pustle,  and  may  be 
repeated  two  or  three  times  a  day. 

Internal  Treatment — The  internal  treatment  should  be  confined  to 
the  administration  of  siimulants  and  plenty  of  nutritious  food.  Davies- 
Colley  advises  ipecacuanha  powder  in  doses  of  five  to  ten  grains  every 
three  or  four  hours.  In  the  malignant  form,  particularly  the  intestinal 
variety,  little  can  be  done.     Keep  the  bowels  active. 

ERYSIPELAS  OR  ST.  AITTHONY'S  FIRE. 

Definition. — This  is  a  specific,  contagious  inflammation  of  the  skin, 
tending  to  spread  over  large  portions  of  the  ciitaneous  surface  with  the 
usual  signs  of  inflammation — pain,  heat,  redness  and  swelling. 

Causes. — This  complaint  has,  as  a  rule,  for  its  starting  point  some 
slight  wound  or  abrasion  of  the  skin,  although  occasionally  it  seems  to  arise 
spontaneously,  affecting  the  head  and  face  in  such  instances  more  fre- 
quently than  any  other  portion  of  the  body.  It  is  particularly  prevalent 
in  the  spring  of  the  year.  It  can  be  conveyed  by  a  third  person.  The 
poison  certainly  attaches  itself  to  clothing,  furniture  and  bed-room  walls. 
Recently  delivered  women  and  persons  who  have  been  the  subjects  of 
surgical  operations  are  particularly  susceptible  to  it. 

Predisposing^  Causes. — Predisposing  causes  are  Bright's  disease,  alco- 
holism and  debility.  The  specific  agent  of  the  disease  is  a  strejDtococcus 
gi-owing  in  long  chains,  the  streptococcus  erysipelatous.  * 

Symptoms — Period  of  incubation  is  variable  from  one  to  eight  days. 
The  stage  of  invasions  is  often  marked  with  a  rigor  and  followed  by  a 
rapid  rise  in  temperature  and  other  signs  of  an  acute  fever,  when  there 
is  a  local  abrasion,  the  spot  is  slightly  reddened,  but  if  the  disease  is  idio- 
pathic there  is  seen  within  a  few  hours  a  slight  redness  over  the  bridge  of 
the  nose  and  on  the  cheeks.  The  swelling  and  tension  of  the  skin  increase 
and  within  twenty-four  hours  the  external  symptoms  are  well  marked. 

The  Skin — The  skin  is  smooth,  tense  and  cedematous.  It  looks  red, 
feels  hot  and  the  superficial  layers  of  the  skin  may  be  lifted  as  small  blebs. 
The  swelling  increases  rapidly,  and  during  the  second  day  the  eyes  are 
usually  closed. 


BLOOD  POISON.  347 

Fnrtlier  Symptoms. — The  first  affected  parts  gradually  become  pale 
and  less  swollen  as  the  disease  extends.  When  it  reaches  the  forehead 
it  progresses  as  an  advancing  ridge,  perfectly  well  defined  and  raised; 
and  often  on  palpation  hardened  extensions  can  be  felt  beneath  the  skin, 
which  is  not  yet  reddened.  Even  in  cases  of  modei-ate  severity  the  face 
is  enormously  swollen,  the  eyes  closed  and  the  lips  oedematous,  the  ears 
thickened,  the  scalp  is  swollen  and  the  patient's  features  quite  unrecog- 
nizable. 

Blood  Poisoning. — The  lymphatic  vessels  and  glands,  especially  the 
cervical,  are  almost  always  more  or  less  affected,  and  poisoning  of  the 
blood  as  in  pyemia  not  infrequently  occiirs.  One  attack  of  the  disease, 
so  far  from  affording  any  protection,  generally  leaves  the  patient  par- 
ticularly susceptible  to  the  malady  for  a  long  time,  perhaps  for  life. 
Delirium  is  present,  the  tongue  becomes  dry,  the  pulse  feeble  and  there 
is  marked  tendency  to  death  from  toxemia.  In  the  majority  of  cases, 
however,  even  with  extensive  lesions  the  constitutional  disturbances,  con- 
sidering the  height  of  the  fever  range,  are  slight. 

Treatment. — Isolation  must  be  carried  out.  A  practitioner  in  attend- 
ance on  a  case  of  this  disease  should  not  attend  a  woman  in  confinement. 
The  disease  is  self-limited,  and  a  large  majority  of  cases  get  well  without 
any  internal  medication. 

Diet — The  diet  should  be  nutritious  and  light.  Stimulants  are  not 
required,  except  in  the  old  and  feeble.  For  sleeplessness,  restlessness  and 
delirium  chloral  and  the  bromides  may  be  given,  or  if  these  fail,  opium ; 
when  the  fever  is  high  the  patient  may  be  bathed  or  sponged.  Of  the 
internal  remedies  the  tincture  of  the  perchloride  of  iron  has  been  highly 
recommeuded. 

local  Treatment. — ^For  the  local  treatment,  two  per  cent,  solutions  of 
carbolic  acid,  the  corrosive  sublimate  solution  1  to  2,000.  In  the  Poly- 
clinic Hospital  in  Philadelphia  the  application  of  ichthyol  ointment  over 
the  reddened  area,  and  should  there  be  a  wound,  washing  it  out  with 
normal  salt  solution  have  proved  very  efficacious.  To  prevent  spreading, 
paint  the  margin  of  the  inflammation  with  tincture  of  iron. 

SEPTICEMIA  OR  BLOOD  POISON. 

Definition It  is  a  condition  in  which,  with  or  without  a  local  site 

of  infection,  there  is  a  microbic  invasion  of  the  blood  and  tissues,  but 
in  which  there  are  no  foci  of  suppuration. 


348  THK  ERUPTIVE  DISEASES. 

Symptoms. — Illustrative  cases  of  the  more  usual  form  of  septicemia 
are  puerperal  fever,  following  a  retained  placenta,  infection  by  scarlet 
fever,  or  difficult  labor  involving  lacerations  and  the  poisoning  by  a  dis- 
secting wound.  Tbe  symptoms  set  in  from  three  hours  to  four  days, 
v.sually  twenty-four  hours. 

Initial  Symptoms.- — The  usual  initial  spnptom  is  a  chill  varying  in 
severity;  it  may,  however,  be  preceded  by  a  headache  and  malaise  and  is 
always  followed  by  a  high  fever.  In  bad  cases  the  chill  is  repeated  daily 
and  the  temperature  rises  high.  I  have  knovai  of  one  instance  in  which 
it  went  to  10G.7  degrees  Fahrenheit.  The  patient  is  restless,  the  tongue 
at  first  red  and  glazed  becomes  dry  and  leathery,  the  pulse  at  first  full  and 
bounding  becomes  weak  and  compressible  with  a  rate  of  130  or  more. 
Prostration  is  marked. 

The  Fever — The  fever  is  subject  to  remissions  which  give  rise  to  the 
inexperienced  to  delusive  hope.  The  chill  is  followed  by  profuse  sweating 
and  further  prostration,  the  mind  early  begins  to  wander  and  delirium 
of  the  low  muttering  kind  is  soon  established.  There  is  a  tenderness  over 
the  abdomen  in  puerperal  cases  and  in  all  a  tendency  to  enlargement  of 
the  spleen  with  hypostatic  congestion  of  the  lungs  and  often  broncho- 
pneuniiiiiia  will  result. 

Diagnosis. — This  is  usually  easy,  the  resemblance  of  the  more  serious 
form  to  intermittent  fever  has  been  referred  to.  In  this  disease  the 
remissions  are  not  so  total  and  the  patient  remains  very  ill. 

Treatment. — In  treatment  all  possible  infecting  foci  should  be  re- 
moved by  surgical  methods;  after  this  the  strength  should  be  supported 
by  quinine,  strychnine  and  stimulants.  The  food  should  be  liquid  and 
of  the  most  nourishing  kind.  The  fever  should  be  reduced  with  cold 
sponging  and  quinine. 

PYEMIA  OR  PUS  BLOOD  POISON. 

Definition. — Pyemia  is  a  general  febrile  affection  due  to  sepsis,  char- 
acterized by  recurring  chills  and  profuse  sweats  with  remissions  or  inter- 
missions in  the  fever,  also  by  abscesses  variously  disseminated  in  the 
different  tissues  and  organs  of  the  body. 

Causes. — The  same  essential  cause  lies  at  the  bottom  of  pyemia  as 
of  septicemia,  but  associated  with  this  disease  are  the  important  etio- 
logical factors,  thrombosis  and  embolism.  Fragments  of  a  venous  throm- 
bus, due  to  a  phlebitis  at  the  seat  of  putrid  inflanmiation,  are  broken 
off  and  carried  in  the  circulation  until  a  lodgment  !s  effected.     These 


PUS  BLOOD  POISOIT.  349 

fragments  swarm  with  bacteria  and  tbe  embolus  excites  intense  inflam- 
mation, which  goes  on  to  abscess  formation.  The  emboli  may  lie  multiple, 
and  there  will  be  as  many  abscesses  as  there  are  emboli.  The  seats  of 
election  are  lungs,  liver,  spleen,  kidneys,  brain  and  joints  and  the  various 
connective  tissues  in  the  order  above  given. 

Other  Causes — Other  causes  are  gunshot  injuries  of  bone  and  com- 
pound fractures,  gonorrhoea  and  prostatic  abscesses. 

Symptoms. — A  rapidly  rising  fever,  often  so  closely  followed  by  a 
chill  that  its  previous  existence  is  often  not  suspected.  The  severity  of 
the  chill  is  proportionate  to  the  intensity  of  the  infection.  The  tempera- 
ture during  the  chill  reaches  103  degrees  to  105  degrees  Fahrenheit,  and 
is  followed  by  a  sweat  and  fall  in  temperature,  after  which  the  latter 
rises  again  to  a  point  even  righer  than  was  at  first  attained.  The  tempera- 
ture may  rise  and  fall  several  times,  but  as  a  rule  each  one  goes  higher 
than  the  preceding  one. 

Other  Symptoms. — The  other  symptoms  of  fever  are  also  present, 
thirst,  loss  of  appetite  and  nausea.  The  strength  of  the  patient  rapidly 
wanes  and  he  soon  sinks  into  a  condition  of  exhaustion  and  semi-conscious- 
ness from  which  he  may  be  aroused  to  take  medicine  and  nourishment. 

Diagnosis  is  not  usually  difficult ;  a  careful  study  of  the  case  will  show 
marked  differences  in  history  to  typhoid  fever  and  malarial  fever.  There 
are  no  rigors  followed  by  sweats  in  typhoid,  and  finding  tlie  plasmodium 
malaria;  in  the  blood  of  suspected  patient  will  settle  the  case  should  it  bo 
malaria. 

Treatment  is  like  that  of  septicemia.  Remove  the  foci  of  infection 
surgically,  and  after  that  the  symptoms  are  to  be  combated  and  the 
strengih  supported  to  the  utmost. 


PART  II  OF  BOOK  IV 

Treats  of   the  constitutional  diseases,   their  causes, 
diagnoses,  prognoses  and  treatments. 


Acute    Bright's    Disease 395 

Acute   General   Dropsy 393 

Acute  Rheumatism    353 

Causes  of 354 

Symptoms  of   353 

Treatment  of   3S6 

Anemia   389 

Causes  of 389 

Diet  in   390 

Symptoms  of   389 

Treatment  of   390 

Arthritic  Rheumatism  361 

Beri-Beri    39i 

Causes  of   39i 

Symptoms  of   391 

Treatment  of   , 391 

Bright's   Disease    395 

Acute    395 

Causes  of  395 

Chronic    395 

Diet  in   395 

Symptoms  of   395 

Treatment  of   395 

Cancer   363 

of  Bones   Z7i 

of  Brain   371 

Causes  of  367 

Colloid    372 

Diet  in   374 

of  Duodenum  371 

of  Kidney   371 

of  Liver   371 

Membranous    373 

Prevention  of   364 

Skin   373 

Soft    373 

of  Spleen  371 

Symptoms  of  369 

Transmission  of   367 

Treatment  of   374 

of  Uterus 37i 


Cancerous   Dropsy    372 

Carcinoma    363 

Chronic    Bright's    Disease 395 

Diet  in    397 

Symptoms  of   396 

Treatment  of   396 

Clironic  Gout   362 

Chronic   Rheumatism   359 

Symptoms  of   359 

Treatment  of   360 

Colloid    378 

Cancer    372 

Constitutional  Diseases,  The 353 

Cretinism   384 

Causes  of   384 

Symptoms  of   384 

Treatment  of   385 

Diabetes   385 

Causes  of  385 

Diet  in    386 

Mellitus    383 

Symptoms  of   385 

Treatment  of   386 

Dropsy,  Acute  General  393 

Cancerous    372- 

Diet  in  394 

General    392 

Local    392 

.    Symptoms   of    392 

Treatment  of 393 

Dry  Leprosy   379 

Elepliantiasis    379 

Fever,  Riicumatic   353 

General  Dropsy   391 

Gonorrheal   Rheumatism   361 

Gout   361 

Causes  of   362 

Chrenic    362 

Hereditary    362 

Symptoms  of 361 

Treatment  of 36« 

351 


352 


INDEX   TO   PAKT    II   OF    BOOK   IV. 


Hereditary   Gout    3^2 

Land  Scurvy    386 

Causes  of   386 

Symptoms  of  386 

Treatment  of   387 

Leprosy    379 

Causes  of  379 

Dry    379 

Symptor.13  of   379 

Treatment  of  380 

Local  Dropsy   392 

Lumbago    358 

Treatment  of 358 

Lupus    37S 

Symptoms  of   378 

Treatment   of    378 

Malignant  Disease 363 

Melanosis   373 

Membranous   Cancer    373 

Muscular  Rheumatism  358 

Neck,  Stiff   358 

Noli   MeTangere    378 

Ophthalmia    382 

Diet  in  382 

Symptoms   of    382 

Treatment   of    382 

Pain  in  the  Side  358 

Treatment  of 359 

Pleurodynia    3S8 

Podagra    361 

Purpura   386 

Rheumatic  Fever  353 


Rheumatism,   Acute    353 

Arthritic    361 

Chronic    359 

Gonorrheal   361 

Muscular    358 

Syphilitic    361 

Rickets    383 

Causes  of   383 

Diet  in   384 

Symptoms  of 383 

Treatment   of    384 

Scorbutus    388 

Scrofula .3S1 

Causes  of   381 

Symptoms  of 381 

Treatment   of    381 

Scurvy   380 

Causes  of   388 

Diet  in  389 

Land    386 

Symptoms  of 388 

Treatment  of   388 

sSkin   Cancer   373 

Soft  Cancer   373 

Stifif   Neck    358 

Treatment'  of   358 

Sj'philitic   Rheumatism    361 

LTraemia   397 

Uraemic  Poisoning  397 

Causes  of   397 

Symptoms   of    397 

Treatment  of  398 


CURATIVE  MEDICINE 


PAKT  II. 


THE  CONSTITUTIONAL  DISEASES 

Meaning  of  Constitutional  Diseases. — By  constitutional  or  organic  dis- 
ease is  generally  meant  a  visible  disorder  of  structure;  that  disease  and 
disorder  are,  however,  essentially  the  same  thing,  is  clear  from  the  cir- 
cumstance that  function  and  organism  are  united.  The  state  of  the  organ 
will  always  influence  the  functiou,  just  as  a  power  aiDplied  to  any  ma- 
chinery will  produce  effects  according  to  the  nature  of  the  machine  and 
the  materials  acted  upon.  The  power  and  function  of  the  machine  are 
dependent  on  its  intrinsic  mechanism,  though  set  to  work  by  an  extrinsic 
influence.  The  mode  of  working  is  not  visible  in  the  vital  organs,  nor 
are  the  functions  of  life  mechanical,  except  so  far  as  they  act  in  time  and 
space. 

ACUTE  HHETJMATISM  OR  RHEUMATIC  FEVER. 

Symptoms. — Acute  rheumatism  is  an  inflammation  of  the  joints, 
characterized  by  general  fever,  by  pain,  heat,  redness  and  swelling  of  the 
joints  affected,  and  by  a  tendency  to  leave  one  joint  suddenly  and  fasten 
upon  another.  The  affection  sometimes  commences  by  chills  and  fever, 
and  general  uneasiness ;  and  these  symptoms  (rheumatic  fever)  may  last 
for  twenty-four  hours  or  more  before  the  local  manifestations  show  them- 
selves. More  frequently  the  local  symptoms  make  their  appearance  at  the 
same  time  with  the  fever,  and  occasionally  they  are  present  some  little 
time  before  it  supervenes. 

The  Pain — The  pain  in  the  joint  or  joints  affected,  commonly  but 
little  felt  while  the  patient  is  perfectly  quiet,  becomes  intense  on  the 
slightest  motion,  so  that  he  is  rendered  completely  helpless.  The  super- 
ficial joints  become  swollen  and  tense,  they  are  hott«r  than  natural,  and 
the  skin  covering  them  is  generally  more  or  less  reddened. 

The  Swelling. — The  swelling  is  sometimes  mainly  caused  by  effusion 
within  the  capsular  ligament  of  the  joint  itself,  at  others  by  the  inflamma- 
23,  (353) 


354  CONSTITUTIONAL  DISEASES. 

tion  and  thickening  of  the  tibrons  tissues  external  to  the  joint.  The  pulse 
is  geuerally  full,  strong  and  moderately  frequent,  rarely  rising  over  100 
heats  in  a  minute;  the  skin  is  warm  and  copious  sour  perspirations  are 
commonly  present;  the  tongue  is  thickly  coated,  the  bowels  somewhat 
constipated  and  the  appetite  completely  lost. 

Freaks  of  Iniammation — The  inflammation  at  first  affects  one  or  two 
joints,  rarely  three ;  after  a  variable  time  it  commonly  leaves  the  joints 
first  affected  as  suddenly  as  it  attacked  them,  and  fastens  on  some  other 
articulation ;  often,  however,  new  points  are  attacked  without  the  disease 
leaving  its  orig-inal  seat.  As  a  rule  the  larger  joints  are  the  ones  most 
liable  to  be  attacked,  the  knees,  elbows,  ankles,  wrists  and  hips;  more 
rarely  the  smaller  joints  of  the  toes  and  fingers  become  affected. 

Heart  Attack. — Besides  the  articulations,  acute  rheumatism  fre- 
quently attacks  the  heart,  not  by  metastasis  or  transferrence  of  the  inflam- 
mation from  one  part  to  another,  but  by  seizing  on  the  fibrous  textures  of 
the  heart  as  in  one  of  the  series  of  textures  liable  to  the  disease.  Some- 
times the  pericardium  is  attacked  (pericarditis),  sometimes  the  lining 
membrane  of  the  heart's  cavities  (endocarditis).  The  younger  the  patient 
the  more  liable  is  the  heart  to  be  affected;  so  that  when  rheumatism 
occurs  previous  to  the  adult  age  the  heart  is  attacked  in  a  large  majority 
of  cases. 

Rheumatism  Hereditary — The  rheumatic  constitution  is  frequently 
hereditary,  and  rheumatism  is  peculiarly  a  complaint  of  cold,  damp  sea- 
sons and  climates. 

Causes — The  cause  of  rheumatism  has  provoked  more  thought  and 
research  than  any  of  the  commoner  diseases;  at  least  one  type  of  the 
disease  is  due  to  excess  of  fibrin  in  the  blood.  There  is  an  exudation  of 
this  fibrinous  material  into  the  sheaths  of  nerves  about  tendons,  especially 
where  inserted  into  the  bone,  the  fascise  of  muscles,  the  serous  capsules 
of  organs,  their  ligamentous  attachments,  in  joints,  heart  valves,  and  so 
forth,  wherever  fibrous  tissue  is  found  normally.  This  fibrinous  exudate 
organizes  into  bands,  fungus,  nodules,  and  so  forth,  of  cicatricial  tissue, 
obstructing  circulation  and  movement  of  parts  and  modifying  cell  nutri- 
tion. The  presence  of  this  fibrinous  exudate  makes  the  muscles  hard  and 
stiff,  so  that  they  contract  with  difficulty  and  pain,  yet  appear  large  and 
strong.  Impinging  upon  nerves  it  causes  pain  and  perverted  nerve  action. 
Especially  is  this  the  case  where  the  deposit  occurs  near  the  bony  opening 
whence  tlie  nerves  emerg 

The  Fibrous  Exudation. — This  fibrinous  exudate  is  precisely  like  the 


ACTTTE  RHEUMATISM.  355 

membrane  of  diplitlieria,  of  membranous  dysmenorrhea,  colitis  and  croup, 
the  exudate  in  lobar  pneumonia,  and  so  forth.  Its  appearance  in  the  mus- 
cles and  other  structures  is  also  preceded  by  a  similar  weakening  of  the 
vaso-motor  nerves.  When  the  blood  gets  into  this  hyjjerjjlastic  state  it 
must  get  rid  of  the  excess  of  fibrin-forming  materials  in  some  way,  or  it 
would  finally  solidify,  organize  like  a  clot,  and  the  individual  turn  to  stone. 
So  nature  sounds  the  alann,  and  sacrifices  a  part  to  save  the  organism. 
But  sometimes  her  warnings  are  not  heeded. 

A  Chief  Cause. — The  chief  exciting  cause,  we  know,  is  the  application 
of  cold  to  the  body  when  unusually  heated.  Cold  is  more  liable  to  pro- 
duce this  effect  when  combined  with  moisture,  whence  a  cold  and  humid 
atmosphere  and  wet  or  damp  clothes  are  the  most  frequent  sources  to 
which  rheumatism  can  be  traced.  Partial  cold,  as  when  parts  of  the  body 
are  subjected  to  currents  of  cold  air,  is  very  apt  to  give  rise  to  rheumatism ; 
when  the  body  is  predisposed  a  very  transitory  exposure  of  this  kind  will 
suffice  to  bring  on  an  attack ;  if  the  ciirrent  be  sustained  for  any  time,  few 
will  wholly  escape  some  contingent  suffering.  Of  the  fact  that  rheuma^ 
tism  is  so  excited  there  can  be  no  doubt.  When  it  is  reflected,  however, 
that  for  every  instance  of  rheumatism  so  induced,  numbers  continually 
endure  as  much  or  greater  exposure  to  the  alleged  cause  without  any 
disease  ensuing,  too  much  importance  should  not  be  attached  to  it. 

Diagnosis — The  only  disease  with  which  it  is  liable  to  be  confounded 
is  gout.  Formerly  discrimination  in  this  respect  was  deemed  of  high 
imijortance,  the  prevailing  theories  of  gout  demanding  a  course  of  treat- 
ment very  different  from  that  to  which  rheumatism  was  subjected.  In  the 
present  day  a  juster  pathology  of  gout  assimilates  the  treatment  of  both 
diseases  sufficiently  to  render  extreme  accuracy  of  discrimination  of  very 
slight  moment. 

Prognosis. — The  prognosis  is  dependent  on  the  promptitude  with 
which  suitable  treatment  is  resorted  to.  Generally  speaking,  there  is  little 
immediate  danger  to  life,  there  being  no  inflammatory  disease  of  equal 
intensity  which  so  little  deranges  the  vital  functions.  This,  most  proba- 
bly, is  owing  to  the  disease  expending  its  violence  in  the  joints  and  other 
external  parts,  and  being  little  prone  to  attack  the  viscera.  The  peculiar 
character  of  the  inflammatory  action,  too,  and  the  little  liability  which 
it  has  to  pass  into  suppuration,  or  undergo  the  other  changes  consequent 
to  phlegmonous  inflammation,  may  account  for  the  safety  with  which 
even  the  metastasis  of  rheumatism  to  internal  parts  is  borne.    It  is  certain 


356  CONSTITUTIONAL  DISEASES. 

that  such  metastasis  is  not  attended  with  so  much  danger  as  the  severity  of 
the  Bviuptoms  would  seem  to  denote. 

Management  of  Acute  Rheumatism — One  of  the  most  important  points 
in  the  management  of  acute  rheumatism  is  to  watch  the  supervention  of 
the  morbid  action  in  the  fibro-serous  tissues  of  the  heart.  It  is  not  neces- 
sary to  repeat  here  the  symptoms  of  pericarditis  and  endocarditis,  hut  the 
occurrence  of  dyspnoea,  with  more  or  less  anxiety,  jerking  or  feeble  and 
rapid  jiulse  and  tumultous  action  of  the  heart  ought  to  direct  the  atten- 
tion of  the  practitioner  to  that  viscus,  and  if  he  discovers  by  the  physical 
signs  and  functional  phenomena  the  existence  of  inflammatory  action 
there,  it  must  be  treated  as  if  the  disease  were  unconnected  with  rheuma- 
tism, for  no  truth  is  better  established  than  that,  although  acute  rheuma- 
tism, seated  in  the  fibrous  and  muscular  tissues  around  the  joints,  is 
remarkable  for  its  great  and  rapid  change  of  location;  chronic  rheuma- 
tism loses  this  mobility  when  it  fixes  upon  a  serous  membrane. 

Treatment — 1.  Acute  rheumatism  produces,  we  have  seen,  diseases  of 
the  heart;  it  is,  therefore,  incumbent  on  the  practitioner  to  prevent  the 
continuance  of  the  rheumatic  inflammation  of  the  serous  membrane  of  the 
heart.  The  indications  are  to  subdue  fever  and  remove  inflammation. 
The  promptitude  with  which  the  local  inflammation  in  its  earliest  stage 
yields  to  the  treatment  by  which  a  plethoric  state  of  constitution  is  cor- 
rected, and  febrile  action  allayed,  and  the  obstinacy  of  the  local  ailments, 
whenever  the  constitutional  state  is  overlooked  or  inadequately  treated, 
furnish  the  best  proofs  of  the  correctness  of  this  pathology. 

2.  The  treatment  has  been  pursued  in  various  ways — ^bleeding,  mer- 
curials, mercurials  with  Durgatives,  opium,  sulphate  of  quinine  and  nitrate 
of  ootassa  in  large  doses  have  been  at  various  times  resorted  to.  Of  these 
methods,  tnose  by  large  doses  of  sulphate  of  quinine  and  by  nitrate  of 
potassa  nave  seemed  to  have  an  influence  in  controlling  and  cutting  short 
the  disease,  and  the  treatment  by  quinine  appears  to  be  successful  in  the 
acutest  and  most  violent  attacks;  but  they  are  both  subject  to  incon- 
venience and  dangers  which  coimterbalance  their  advantages. 

3.  The  treatment  which  is  most  generally  relied  on  is  the  alka- 
line. Our  aim  being  to  liquefy  and  eliminate  the  fibrinous  deposit. 
The  iodides,  ammonia  preparations,  jaborandi,  hot  vapor  baths,  massage, 
and  counter-irritation  have  all  been  employed ;  overfeeding,  especially 
with  meats  and  highly  concentrated  foods,  should  bo  rigorously  avoided. 
Persons  having  this  fibrous  diathesis  should  employ  a  resolvent  treatment 
at  intervals,  for  weeks  at  a  time.     Exercise  must  be  systematic,  and  too 


ACUTE  RHEUMATISM.  357 

much  cannot  be  said  of  the  value  of  hot  vapor  baths,  massage  and  joint 
movements. 

4.  If  the  heart  shows  signs  of  being  affected,  and  embolism  or  phle- 
bitis occur,  use  ammonia,  carbonate  and  acetate  with  nitro-glycerine, 
warmth  to  and  rubbing  of  extremities  with  mercury  to  move  the  bowels. 
The  old  custom  of  venesection  and  cups,  in  vigorous  subjects,  was  very  fair 
practice.  It  made  the  patient  thirsty  and  so  called  for  diluents  to  thin 
the  viscid  blood.  The  cups  relieved  engorged  parts,  and  paved  the  way 
for  a  better  circulation  through  them. 

5.  The  fibrous  diathesis  varies  from  that  of  the  uric  acid,  and 
the  same  treatment  will  not  always  relieve  the  rheumatic  pains  of  both. 
In  the  former,  there  is  a  tendency  to  congestion  of  the  brain,  the  liver 
and  kidneys  are  apt  to  be  sluggish.  In  the  uric  acid  type  of  rheuma- 
tism irritability  is  contrasted  with  the  torpor  which  characterizes  the 
fibrous.  Enlarged  joints  are  common,  and  storms  of  disease  sweep  over  the 
system.  Muscular  development  is  slight,  and  the  powers  of  endurance 
small.  In  the  fibrous  diathesis  the  patient  is  well  developed,  tough  and 
resisting. 

As  rheumatism  is  invariably  accompanied  by  loss  of  appetite  and 
embarrassed  metabolism,  it  is  naturally  the  result  of  accumulated  secre- 
tions and  imperfect  excretion,  hence  it  is  best  treated  by  freeing  the 
bodily  outlets  and  carefully  measuring  the  supplies.  While  recognizing 
the  necessity  of  salicylate  treatment,  we  would  advise  that  such  be  com- 
bined with  mild  cholagogues,  diaphoretics  and  diuretics.  The  salicylate 
appears  to  exert  a  general  action  on  all  the  excretions  in  the  exact  pro- 
portion in  which  such  is  needed. 

6.  If  any  organ  requires  but  little  correction,  it  receives  no  more, 
and  on  that  account  sufficient  force  is  retained  to  exercise  itself  where  it 
is  more  in  demand.  As  a  result,  the  beneficial  effects  of  the  salicylic  acid 
treatment  are  utilized  to  their  fullest  extent  without  being  followed  by  bad 
reactionary  conditions. 

Treatment Kest  in  bed  and  the  parts  kept  warm.     The  affected 

parts  should  be  wrapped  in  cotton.     Give  freely  alkaline  mineral  waters 
In  the  strong  frequent  doses  of  salicylic  acid  or  the  salicylates. 

R.— Acid   Salicylic    l%   drachms 

Sodii    Bicarb 2       drachms 

Tr.   Card.    Co 6       drachms 

Syrup     1^2   ounces 

Water  q.  s.  to  make  four  ounces. 

Two  teaspoonfuls  every  three  or  four  hours. 


358  CONSTITUTIONAL   DISEASES. 

Or, 

R. — Sodii    Salicylate    3  drachms 

Syrup     2  ounces 

Water   of    peppermint    2  ounces 

Two  teaspoonfuls   every   three  or   four  hours   until  relieved. 

Or  five-grain  closes  of  aspirin  every  three  or  four  liours.  The  alka- 
line treatment  can  he  used  hy  giving  the  following: 

R. — Potass.    Bicarb i   drachm 

Lemon   juice    2  drachms 

Water     I   ounce 

After  the  acute  symptoms  and  pain  have  subsided,  Basham's  Mix- 
ture in  dessertspoonful  doses  three  or  four  times  a  day.  Oil  of  winter- 
green  applied  to  the  affected  joint  will  often  relieve  the  pain. 

MUSCULAR  HHEUMATISM. 

Of  the  minor  painful  maladies  this  is,  perhaps,  the  most  common  in 
many  parts  of  the  country.  It  may  attack  any  muscle,  but  its  three  most 
decided  and  painful  phases  are  lumbago,  stiff  neck  and  pain  in  the  side 
(pleurodynia),  all  of  which  yield  to  the  same  or  analogous  treatments. 

Lumbago. — This  affects  the  large  muscles  of  the  back  and  loins, 
sometimes  extending  to  the  lowest  parts  of  the  spine.  The  pain  is  severe 
and  often  of  sudden  occurrence,  very  much  as  if  one  had  sprained  his 
back. 

Treatment Apply  locally  chloroform  liniment  on  hot  flannel.     A 

porous  plaster  is  often  effective.  Assume  and  hold  a  restful  position. 
Take  internally  two  gTains  each  of  quinine  and  phenacetin,  with  one 
twelfth  of  a  grain  of  belladonna  every  three  hours  until  relieved. 

Stiff  Neck. — This  is  also  called  cervical  rheumatism.  It  affects  the 
large  muscle  at  the  side  of  the  head  behind  the  ear,  extending  down  to  the 
collar  or  even  the  breast  bone. 

Treatment. — Apply  locally  chloroform  liniment  on  hot  flannel.  As- 
smne  and  keej)  a  restful  position.  Take  internally  two  grains  each  of 
quinine  and  phenacetin,  with  one-twelfth  of  a  grain  of  belladonna  every 
three  hours  until  relieved. 

Pain  in  the  Side  (Pleurodynia)  arises  from  a  rheumatic  affection  of 
the   muscles   concerned   in   breathing,    especially   the    short,    flat  muscles 


CHRONIC    RHEUMATISM.  359 

between  tbe  ribs,  called  intercostal  muscles.  It  is  also  called  intercostal 
rheumatism.  The  pain  produced  resembles  that  of  pleurisy,  and  some- 
times excites  alarm  lest  some  more  serious  disease  is  present.  A  test  of 
the  lungs  with  the  stethoscojie  Avill  detennine  whether  the  condition  is 
pleuritic  or  not.  Absence  of  cough  or  fever,  and  soreness,  upon  touch, 
of  the  muscles  on  the  side  affected,  also  show  that  pleurisy  is  not  present. 
Treatment. — 1.  As  in  all  cases  of  muscular  rheumatism,  put  the 
affected  muscles  at  rest  as  far  as  possibile.  Of  course  this  will  be  hard 
to  do,  because  these  muscles  are  engaged  as  helps  in  respiration,  but  the 
object  may  be  aided  by  applying  strips  of  adhesive  plaster,  overlapping 
each  other,  around  the  affected  side,  so  as  to  compress  it  tightly. 

2.  Apply  an  ordinary  porous  jjlaster  to  the  side  affected. 

3.  Treat  internally  by  taking  every  three  hours,  until  relieved,  a 
dose  consisting  of  two  grains  each  of  quinine  and  phenacetin,  witli  two 
grains  of  Dover's  powder. 

4.  Fifteen  drops  of  wine  of  colchicum,  with  a  quarter  of  a  grain  of 
opium,  used  in  very  small  but  often  repeated  doses,  is  often  beneficial  in 
all  the  above  forms  of  muscular  rheumatism. 

6.  In  all  of  the  above  forms  of  muscular  rheumatism — ^lumbago, 
stiff  neck  and  pleurodynia — where  the  suffering  is  intense,  a  hypodermic 
injection  of  a  quarter  of  grain  of  morphia  will  afford  prompt  relief. 

CHRONIC  RHEUMATISM. 

Character — The  distinctive  characters  of  this  malady  are  a  febrile 
state  of  the  general  system,  with  more  or  less  pain  and  swelling  in  certain 
tissues  and  joints.  And  in  this,  precisely  as  in  acute  rheumatism,  the  con- 
tinuance of  febrile  action  undermines  the  general  health,  while  the  local 
inflammation,  however  indolent,  disorganizes  the  joints,  occasioning  even- 
tual decrepitude.  The  pain  and  swelling  of  joints  with  progressive 
thickening  of  the  ligaments  and  effusion  in  the  several  bursse  sufficiently 
evince  the  morbid  actions  from  which  such  effects  result.  But  coincident 
with  these  will  generally  be  found  a  quickened  pulse,  some  inercasod  heat 
of  skin  and  a  furred  tongue. 

Symptoms. — Chronic  rheumatism  presents  itself  under  two  forms.  In 
one  of  tlie  joints  are  swollen  and  painful,  the  pain  being  aggi'avated  by 
motion;  there  is  no  general  fever  and  the  appetite  may  be  good  and  the 
digestion  sound.  The  affection  is  exceedingly  obstinate,  attacking  new 
joints  without  leaving  those  first  affected ;  it  frequently  attacks  the  smaller 


360  CONSTITUTIONAL   DISEASES. 

joints,  rendering  them  permanently  swollen  and  deformed,  while  the 
immobility  to  which  the  joints  are  sometimes  reduced  may  cause  atrophy 
of  the  muscles  connected  with  them. 

Gout. — When  the  type  is  precise  and  definite  it  presents  sharply- 
drawn  distinctive  characters  which  distinguish  it  from  gout;  but  it  must 
be  admitted  that  there  are  many  eases  in  which  it  exhibits  so  great  a 
resemblance  to  chronic  gout  that  it  is  almost  impossible  to  establish  an 
absolute  distinction  between  the  two  diseases.  Mobility  is  the  primordial 
character  of  rheumatism ;  this  character  at  once  presents  itself.  •  In  gout — 
on  the  other  hand — mobility  does  not  show  itself  until  the  malady  has 
become  inveterate,  until  the  attacks,  which  at  first  Avere  strictly  local,  have 
frequently  recurred,  or  the  progress  of  the  regular  manifestations  has  been 
interfered  with. 

Treatment — 1.  In  the  treatment  alkalies  and  diuretics  are  of  service, 
also  the  iodide  of  potassa,  while  the  different  mineral  waters  are  frequently 
of  great  service.  Warm  salt  water  baths,  the  use  of  flannel  and  stimulat- 
ing liniments  afford  relief. 

2.  It  would  be  vain  to  enumerate  the  various  stimulants  which 
have  obtained  character  for  the  cure  or  relief  of  this  disease.  The  prin- 
cipal are  the  different  essential  oils;  various  balsams  and  gum  resins; 
sudorific  decoctions;  electricity.  Any  of  these  may  benefit  according  as 
the  general  constitution  is  prepared  for  their  operation,  or  as  the  special 
ailment  may  require.  If  there  be  no  plethoric  or  febrile  state  present, 
their  use  will  at  least  be  harmless,  if  not  beneficial ;  but  should  the  case  bo 
such  as  to  need  depletory  treatment  and  the  operation  of  mercury,  then 
must  the  use  of  such  stimulants  as  are  now  named  be  watched  with  great 
caution.  Warm  bathing  and  active  exercise  are  among  the  unexception- 
able and  most  powerful  means  of  relieving  chronic  rheumatism. 

Local  Treatment 1.  The  local  treatment  as  directed  for  the  regular 

or  acute  rheumatism  also  requires  to  be  assiduously  employed.  For  this 
various  liniments  are  useful ;  none  are  better  than  those  containing  oil  of 
turpentine,  oil  of  wintergreen,  oil  of  sassafras,  ammonia  and  laudanum, 
diluted  with  soap  liniment,  or  where  pain  is  considerable,  chloroform  or 
aconite  liniment.  Blisters  may  be  applied  in  obstinate  cases.  Dry  cup- 
ping to  the  back,  leaving  a  number  of  cups  on  for  twenty  or  thirty  minutes 
at  a  time  makes  a  more  pervading  favorable  impression  sometimes  than 
might  have  been  expected. 

2.  For  rigidity  of  the  joints  and  even  for  pain  in  them  or  in  the 
muscles,  pouring  hot  water  continuously  over  the  parts  does  great  service. 


GOUT    OE   PODAGRA.  361 

The  hot  bath  or  vapor  bath,  or,  as  some  prefer,  the  hot  dry-air  bath  (130 
degrees  to  200  degrees)  will  be  powerful  for  relief  in  many  cases. 

Electric  Treatment — Electricity  also  will  aid  in  hastening  the  restora- 
tion of  use  to  the  stiffened  parts. 

SYPHILITIC  RHEUMATISM. 

This  affects  the  long  and  flat  bones  chiefly,  and  mostly  between  the 
joints,  not  at  them.  Generally  there  is  nodosity  upon  the  bones  affected, 
or  some  degree  of  periosteal  inflammation  at  least.  Our  main  reliance  in 
this  affection  is  the  iodide  of  potassium. 

ARTHRITIC  RHEUMATISM. 

This  designation  is  applied  to  a  form  of  subacute  or  chronic  Inflam- 
mation of  one  or  more  large  joints  of  greater  severity  than  ordinary 
chronic  rheumatism.  Effusion  into  the  joints,  with  deformity  and  perma- 
nent lameness  may  occur.  The  treatment  pursued  in  chronic  rheumatism 
has  proved  beneficial. 

GONORRHEAL  RHEUMATISM. 

A  peculiar  inflammation  of  one  or  more  joints  occasionally  commenc- 
ing in  the  course  of  gonorrhea  or  even  of  urethral  inflammation  from 
forced  catheterism.  The  local  affection  may  be  severe,  with  suppuration 
in  a  few  cases  and  anchylosis  of  the  joint  in  many.  It  appears  to  be  an 
ichorsemic  affection ;  the  result  of  absorj^tion  into  the  blood  of  morbid 
matter  effused  into  the  membrane  of  the  irretbra. 

GOUT  OR  PODAGRA. 

Character — A  painful  disease  affecting  principally  the  fibrous  tissues 
about  the  smaller  joints  and  intimately  connected  with  an  excess  of  uric 
acid  and  its  compounds  in  the  blood.  Various  names  have  been  given 
according  to  the  part  affected,  as  podagra  when  in  the  feet,  chiragra  when 
in  the  hands,  and  so  forth,  but  all  such  and  probably  many  cases  of  neu- 
ralgia, accompanied  by  oxalic  deposits  in  the  urine,  are  mere  forma  of 
one  disease. 

Symptoms. — ^A  common  attack  of  acute  gout  is  generallj'  preceded 
by  uneasiness,  indigestion,  loss  of  appetite,  nausea  and  vomiting,  biliary 
derangement,  dull  pains  or  numbness  in  the  parts  affected,  often  with 


362  CONSTITUTIONAL   DISEASES. 

feverish  symptoms;  but  in  some  cases,  on  the  contrary,  the  disease  comes 
on  in  the  midst  of  apparent  health  and  well-being,  and  occasionally  at 
night  during  refreshing  sleep.  In  most  cases  it  makes  itself  known  by 
an  acute  pain  in  the  joint  of  the  great  toe. 

Further  Symptoms. — This  is  accompanied  by  feverish  symptoms, 
urinary  sediment,  extreme  tenderness,  restlessness,  involuntary  muscular 
contractions,  sleeplessness  and  perspiration;  the  affected  joint  is  swollen, 
red  and  hot.  This  series  of  symptoms  may  last  four  or  five  days,  to  be 
followed  after  a  day  or  two  by  three  or  four  others,  continuing  in  all 
from  two  to  three  weeks;  the  severity  of  the  attack,  its  persistence,  its 
seat  and  its  metastases  vary  according  to  circumstances. 

Chronic  Gout.— When  gout  becomes  chronic  the  attacks  are  more 
irregular,  less  severe,  more  frequent  and  sudden,  leaving  one  joint  for 
another  after  slight  exposure  to  cold  and  moisture,  excess  at  table  or  vivid 
emotions;  in  this  form  the  continuance  of  the  pain  and  the  fear  of  in- 
juring the  gouty  joints  render  its  subjects  cross,  fretful  and  disagreeable. 

Chalky  Deposits. — Toward  the  end  of  the  spell  chalk-like  deposits 
are  thrown  out  about  the  joint  in  some,  but  not  in  all  cases.  The  suffer- 
ing with  the  gouty  inflammation  is  often  very  intense. 

Hereditary  Gout — Hereditary  gout  is  sometimes  podagi-a  or  foot- 
gout,  but  more  often  is  of  the  hardening  kind.  Neuralgia,  indigestion, 
palpitation  and  urticaria  or  eczema  upon  the  skin  are  its  most  common 
manifestations.  In  such  a  system  rheumatism  and  other  affections  are 
to  a  considerable  degree  modified  by  the  "gouty  tendency." 

Causes — High  living  with  indolent  habits  generates  gout.  Even 
excess  of  animal  food,  with  scanty  exercise,  has  been  known  to  produce  it. 
But  strong  wines  and  malt  liquors  much  increase  the  tendency.  Weak 
wines  do  not  seem  to  have  the  same  effect. 

Diagnosis — Between  gout  and  rheumatism  there  is  great  resemblance. 
In  gout  the  small  joints  are  chiefly  affected;  in  rheumatism  the  larger 
joints.  Bepetition  of  attacks  is  much  more  frequent  in  gout;  their  dura- 
tion is  greater  in  rheumatism.  In  gout  the  heart  is  seldom  attacked  and 
spasmodically;  in  rheumatism  the  heart  is  often  subject  to  inflammation. 
In  gout  the  stomach  is  sometimes  spasmodically  affected  with  violent 
symptoms ;  in  rheumatism,  almost  never.  In  gout,  and  not  in  rheumatism, 
uric  acid  is  in  excess  in  the  blood.  In  pure  gout,  colchicum  does  good ;  in 
rheumatism,  hardly  ever. 

I  Treatment. — 1.  There  are  few  diseases  which  have  more  empirical 

, remedies  extolled  for  their  cure  than  gout;  almost  every  drastic  purgative, 


OANCEE,  OK  MALIGNANT  DISEASE.  363 

diuretic,  tonic  aud  narcotic  has  been  pressed  into  the  service  either  for 
external  or  internal  use.  To  say  nothing  here  of  soothing  topical  appli- 
cations, colchicum  has  enjoyed,  and  deservedly,  a  great  reputation  in  the 
treatment  of  gout  and  neuralgia  between  the  attacks  and  in  their  chronic 
forms;  it  is  most  eflicacious  when  it  acts  upon  the  skin  and  bowels.  The 
acetate  of  potash  and  other  alkalies  are  in  favor  both  for  their  diuretic 
property  and  as  alkalizing  the  acid  in  the  blood  and  urine. 

2.  During  the  attack  colchicum  and  the  alkalies  are  the  remedies. 
Wine  of  the  root  of  colchicum  may  be  given  in  ten-  or  twenty-drop  doses 
several  times  daily.  The  stomach  and  bowels  are  sometimes  irritated  by 
large  doses ;  but  for  a  few  days  most  patients  will  bear  fifteen  drops  thrice 
daily.  It  should  be  stopped  when  relief  has  been  obtained.  Carbonate 
of  potassium — ten  to  thirty  grains  at  once  with  half-drachm  doses  of 
rochelle  salts  will  be  important  in  addition.  Opiates  or  other  anodynes 
may  be  craved  by  the  jjatient  during  the  extremity  of  his  pain. 

3.  Gouty  attacks  affecting  the  stomach  or  heart  spasmodically  are 
usually  sudden,  violent  and  jirostrating,  requiring  prompt  stimulation, 
as  brandy,  laudanum,  Hoffman's  anodyne  or  chloroform.  Small  or  mod- 
erate doses  of  one  or  another  of  these  should  be  giver,  at  short  intervals. 
Mustard  plasters  to  the  epigastrium  or  chest  and  back  will  be  important, 
and  the  feet  may  be  placed  in  hot  mustard  water  for  revulsion. 

Diet. — Regulation  of  the  diet  is  of  primary  importance.  But  it 
should  not  be  too  low,  especially  when  the  patient's  habits  have  been 
those  of  free  living.  ISTourishment  must  be  full,  while  the  digestive  power 
is  economized  and  positive  stimulation  avoided.  Attention  to  hygienic 
rules  and  avoiding  exposure  to  dampness,  cold  and  fatigue  of  body  or 
mind  are  absolutely  necessary  as  aids  in  the  treatment  of  this  disease. 
To  promote  all  this  adequate  exercise  is  the  natural  agent,  the  use  of 
which  cannot  be  superseded  by  any  medicines  however  valuable  or  how- 
ever laudctd. 

CA2TCER,  OH  MAIIGNANT  DISEASE. 

Cancer  is  a  disease  the  cause  and  method  of  spreading  of  which  is 
not  tiefinitely  known.  It  starts  by  the  growth  of  cells  in  an  organ  or  skin 
of  the  body  which  are  exactly  like  normal  body  tissue,  but  differ  from  the 
cells  which  are  normal  for  the  organ  in  which  it  develops.  These  ab- 
normal cells  constituting  cancer,  renew  themselves  and  encroach  upon  the 
normal  cells  of  the  organ  involved,  so  that  its  function  is  interfered  with 
and  ultimately  destroyed.     Cancer  of  the  stomach,  liver,  etc.,  grow  until 


364  CONSTITUTIONAL  DISEASES. 

they  encroach  upon  adjoining  organs  and  practically  eats  its  ■way  into  the 
vitals  of  the  patient  until  removal  or  death  occurs.  Cancer  can  spread 
to  other  parts  of  the  body  by  the  poisonous  cells,  from  the  original  seat 
©f  the  growth,  getting  into  the  blood  and  lymphatic  channels.  As  soon  as 
the  wall  of  a  blood  or  lymph  channel  becomes  eaten  through  these  cells 
are  washed  to  other  organs,  and  wherever  they  happen  to  be  checked  start 
a  secondary  growth.  This  habit  of  cancer  cells  traveling  by  the  former 
method  and  starting  up  secondary  tumors  resembling  the  primary  growth 
is  spoken  of  as  "metastasis."  Do  you  know  that  after  thirty-five  years 
of  age  one  in  every  eight  females  and  one  in  every  eleven  males  die  of 
cancer,  that  the  death  rate  from  cancer  between  the  ages  of  fifty  and  sixty 
is  not  surpassed  by  any  other  disease  as  a  cause  of  death  in  women,  and 
only  slightly  by  tuberculosis  in  men. 

"What  are  the  early  signs  or  danger  signals  of  this  scourge,  which, 
if  recognized  by  the  sufferer,  may  save  his  life  ? 

According  to  Dr.  Childe,  the  eminent  English  surgeon,  the  suscep- 
tible localities  for  cancer  are: 

(1)  Cancer  of  the  breast.  Here  the  danger  signal  is  a  small  lump 
or  thickening  of  any  kind.  In  women  over  forty  years  old,  this  lump  is 
a  cancer  from  the  start  in  at  least  90  per  cent,  of  the  cases.  In  a  woman 
of  any  age,  the  finding  of  a  lump  in  the  breast  should  be  immediately 
followed  by  its  removal  by  operation. 

(2)  Cancer  of  the  uterus  (womb).  The  danger  signal  here  is  any 
irregular  bleeding,  especially  after  menopause  (change  of  life),  or  the 
onset  of  a  discharge  in  a  woman  who  has  been  free  from  it  previously,  or 
the  change  in  character  of  a  previously  present  discharge,  so  that  it  be- 
comes more  profuse,  more  foul  or  more  irritating. 

(3)  Cancer  of  the  lip,  mouth  and  tongue.  The  danger  signal  here 
is  a  little  wart  or  sore  that  will  not  heal. 

(4)  Cancer  of  the  skin.  The  danger  signal  here  is  any  sore  that 
will  not  promptly  heal  or  any  wart  or  mole  which  suddenly  begins  to  grow 
rapidly. 

(5)  Cancer  of  the  stomach  and  intestines.  Here  the  danger  signals 
are  not  so  apparent  as  on  the  surface  of  the  body.  After  forty  years  of 
age,  the  onset  of  obstinate  indigestion,  persistent  colicky  pains  in  the  ab- 
domen, persistent  diarrha3a  and  especially  the  vomiting  of  blood  or  the 
pasage  of  blood  in  the  stools.    Loss  of  weight. 

Prevention. — The  cause  of  cancer  is  unknown,  and  whether  contagious 
or  not  is  imsettled.    Therefore,  we  cannot  prevent  its  spread  by  isolating 


OANCEE,  OE  MALIGNANT  DISEASE.  365 

the  person  in  quarantine.  If  the  disease  were  known  to  be  due  to  a  germ  or 
parasite,  insects,  etc.,  then  it  could  easily  be  cured,  as  other  contagious  dis- 
eases, by  destroying  the  cause  and  preventing  others  from  contracting  the 
disease  by  coming  in  contact  with  sufferers  from  cancer.  However,  any 
sufferer  from  cancer  in  a  family  should  be  kept  in  a  separate  room,  and  all 
doors,  windows,  etc.,  screened  to  keep  flies  and  mosquitoes  out,  and  kill 
all  insects  seen  that  may  alight  upon  the  dressings  or  any  exposed  surface 
of  the  body.  Disinfectants  should  be  at  hand  for  the  nurse,  attendant  and 
physician  to  disinfect  their  hands  after  attending  to  the  patient.  All  dis- 
charges, bedclothing,  wearing  api^arel,  dishes,  etc.,  used  by  the  patient 
should  be  disinfected  with  chloride  of  lime  solution  (one  ounce  to  half  a 
pail  of  water)  as  a  precaution. 

Teeatment. — There  is  only  one  way  of  preventing  the  spread  of  this 
disease,  and  that  is  by  immediately  consulting  your  physician  and  inform- 
ing him  of  a  growth  or  mole,  etc.,  or  any  distressing  pain  or  symptoms 
which  affect  any  portion  of  your  body.  Do  not  wait.  Cancer  spreads 
slowly  and  treacherously  until  it  has  gained  a  hold,  and  then  it  may  be  too 
late.  When  the  surgeon  sees  your  case,  submit  to  an  operation  at  once.  If 
the  stomach  or  womb,  etc.,  are  involved,  you  will  be  saved  a  slow  and  pain- 
ful death.  Complete  and  early  removal  of  a  cancer  by  operation  is  the 
safest  cure.  Even  then  it  will  return,  but  these  cases  are  rare  where  the 
patient  has  acted  promptly. 

No  Medicine  Will  Cure  Cancer — ^Avoid  Patent  Medicines They  are 

fakes ;  your  money  will  be  wasted,  while  your  tumor  will  grow.  There 
have  been  numerous  cures  recommended  in  the  treatment  of  cancer  where 
operations  cannot  be  made.  The  best  of  these  is  the  Radium  Treatment. 
This  is  very  expensive,  but  in  time  the  government  and  our  wealthy 
citizens  will  see  that  the  poor  can  receive  treatment  according  to  their 
station  in  life  with  a  nominal  charge  or  fee.  It  has  cured  some  cases,  but 
others  have  succumbed 

Dr.  Seelye,  of  Daytona,  Florida,  JJ.  S.  K.,  recommends  the  treat- 
ment of  cancer  {epithelioma)  by  direct  sunlight,  by  concentrating  the 
rays  of  the  sun  upon  the  growth,  early,  by  means  of  a  magnifying  glass 
such  as  may  be  purchased  imder  the  name  of  a  "reading  glass"  for  half  a 
dollar  or  less.    He  claims  permanent  cures  in  mild  cases  so  treated. 

Common  Form  of  Cancer. — The  most  familiar  and  characteristic  form 
of  cancer  is  that  wliich  attacks  the  female  breast  or  womb,  usually  past 
the  middle  period  of  life.     It  first  appears  as  a  local  induration  situated 


360  CONSTITUTIONAL    DISEASES. 

beneath  the  skin,  in  the  glandular  tissue  of  the  organ,  for  the  most  part  in 
the  neighborhood  of  the  nipple.  It  increases  slowly  in  size,  becomes  ad- 
herent to  the  akin  and  involves  more  and  more  of  the  substance  of  the 
breast. 

Cancer  Pains — In  most  cases  sharp  lancinating  pains  are  experienced 
at  this  time,  sometimes  causing  much  distress.  When  the  glandular  sub- 
stance of  the  breast  has  become  fully  affected,  it  is  also  found  to  be  adher- 
ent to  the  walls  of  the  chest,  so  that  it  can  no  longer  be  moved  from  side  to 
side,  and  the  skin  over  its  whole  surface  is  discolored.  Smooth  in  texture, 
raised  in  irregular  knobs  or  eminences  and  in  spots  red  and  tender. 

The  Ulceration. — The  early  hardness  now  yields  to  local  softening, 
the  skin  gives  way  at  some  prominent  point,  and  the  ulcer  thus  formed 
shows  no  tendency  to  heal,  but  constantly  enlarges  and  discharges  a  dark- 
colored  and  fetid  exudation.  Subsequently  the  morbid  growth  involves 
the  subjacent  muscles,  the  ribs  and  even  the  substance  of  the  lungs.  In- 
ternal cancer,  however,  is  often  developed  as  a  secondary  affection  with- 
out being  directly  continuous  with  the  external  growth.  The  patient  may 
be  gradually  exhausted  by  the  pain,  discharge  and  constitutional  irritation 
dependent  upon  external  cancer  alone,  or  the  fatal  termination  may  be 
principally  due  to  the  secondary  affection  of  the  internal  organs. 

Course  of  Cancer — The  course  of  cancer  is  for  the  most  part  slow, 
requiring  several  years  to  pass  through  its  successive  stages.  This  is  gen- 
erally the  case  in  cancer  of  the  breast.  In  other  forms,  particularly  where 
the  morbid  growth  is  softer  and  more  vascular  at  the  outset  it  often 
terminates  fatally  in  a  few  months  or  even  weeks. 

Train  of  Cancerous  Symptoms. — The  cancerous  humor  possesses  these 
characteristics : 

1.  The  peculiar  jjowcr  of  infiltrating  every  tissue  as  it  encroaches 
ui")on  it. 

2.  It  spreads  to  the  lymjjhatic  glands  of  the  neighborhood  through 
the  absorbents. 

3.  It  affects  the  body  generally  through  the  vascular  system,  thus  giv- 
ing rise  to  secondary  deposits,  that  is  to  say,  to  the  development  of  similar 
growths  in  the  viscera  or  remote  parts,  the  lungs  and  liver  being  particu- 
larly prone  to  its  attack. 

4.  It  is  liable  to  recur  after  removal. 

The  stroma  is  abundant,  tough  and  resisting,  giving  a  tuberoid  cir- 
cumscribed api^earance  to  the  mass  when  superficial.  It  is  of  great  hard- 
ness, and  when  fully  developed  is  firmly  adherent  to  the  adjacent  parts. 


OANOEE,  OB  MALIGNANT  DISEASE.  367 

Upon  sections  it  presents  a  bluish-wliite,  glistening  appearance  and  yields  a 
creamy,  oily  fluid  known  as  cancer  juice.  When  situated  subcutaneously, 
as  in  the  mamma,  the  tumor  commonly  assumes  a  dark  purple  or  livid 
color,  and  is  subject  to  darting,  stinging  or  neuralgic  pains.  It  is  apt  to 
ulcerate,  when  the  sore  will  present  hard  and  everted  edges  and  the  neigh- 
boring lymphatics  will  become  indurated  and  enlarged.  It  is  found  most 
frequently  in  the  mamma,  liver,  stomach  and  rectum.  It  is  more  frequent 
in  women  than  in  men.  It  is  of  slow  growth,  and  rarely  occurs  before 
forty  or  forty-five  years  of  age. 

Causes — The  observations  which  we  have  made  on  the  relative  fre- 
quency of  cancer  as  to  age,  sex-temperament  and  condition  of  life  contain 
the  greatest  part  of  what  we  have  to  say  on  the  predisposing  causes  of  the 
disease.  Among  these  have  long  been  enumerated  the  frequent  and  dire-jt 
operation  of  irritating  substances ;  external  injuries,  especially  blows;  the 
abuse  of  stimulating  potions ;  immoderate  indulgence  in  venery ;  the  de- 
pressing influence  of  moral  afflictions;  bad  food,  conjoined  with  the  de- 
bilitating effects  of  cold  and  otherwise  unhealthy  habitations ;  the  inju- 
rious influence  of  one  or  more  of  these  jjredisposing  causes  on  particular 
organs  being  determined  or  modified  by  the  individual  or  accidental  cir- 
cumstances of  the  case. 

Cancer  May  be  Hereditary — The  frequent  occurrence,  however,  of 
cancer  in  individuals  in  whom  none  of  these  predisposing  causes  seem  to 
have  cooperated  in  the  production  of  the  disease  has  led  many  pathologists 
to  consider  it  as  having  an  hereditary  origin. 

Transmission  of  Cancer  Germ. — The  gei-m  of  the  disease,  or  cancerous 
virus,  is  transmitted  from  the  parent  to  his  offspring.  The  evidence  on 
which  this  opinion  rests  is  shown  in  the  fact  that  the  material  element  of 
the  disease  is  contained  in  the  blood,  and  is  separated  from  this  fluid  after 
the  manner  of  nutrition  and  secretion,  either  in  the  molecular  structure 
or  on  the  free  surface  of  organs;  and  that,  while  the  formation  of  the 
disease  is  thus  going  on,  there  may  be  no  appreciable  physical  or  physi- 
ological modification  of  the  part  in  which  it  is  observed.  It  is  thus  that 
we  meet  with  carcinomatous  tumors  in  the  brain,  which,  from  their  bulk 
and  other  characters,  must  have  existed  long  before  the  functional  disturb- 
ance of  the  organ  gave  signs  of  their  presence ;  and  we  have  an  equally 
striking  example  of  the  silent  development  of  these  tumors  in  the  eye, 
imtil  acting  simply  as  a  foreign  body,  they  obstruct  the  rays  of  light  and 
render  vision  more  or  less  imperfect. 

Cancer  Pimple. — In  persons,  too,  apparently  in  the  enjoyment  of  the 


368  CONSTITUTIONAL   DISEASES. 

most  perfect  health,  -we  often  see  the  disease  making  its  appearance  in  the 
form  of  a  small  pimple,  proceeding  more  or  less  rapidly  in  its  course, 
extending  in  breadth  and  depth  and  terminating  ultimately  in  death,  in 
spite  of  all  the  means  which  art  has  devised.  In  others,  a  similar  pimple 
arises  under  similar  or  even  vmfavorablo  circumstances,  proceeds  like  the 
former  to  ulceration,  and  although  it  may  have  been  neglected,  irritated 
and  excited  from  time  to  time,  disappears  and  leaves  the  patient  in  perfect 
health. 

Diagnosis. — It  is  not  until  carcinoma  has  made  some  progress  that  we 
are  sometimes  able  to  recognize  its  presence  in  internal  organs  by  means  of 
a  careful  consideration  of  the  local  and  general  symptoms  which  we  have 
enumerated.  Little  importance  in  general  is  to  be  attached  to  any  one  of 
them  taken  individually.  But  when  the  local  signs,  viz.,  the  changes 
in  the  bulk,  form  and  situation  of  organs,  occasioned  by  the  disease,  its 
relative  frequency  in  different  organs  and  in  particular  portions  of  the 
same  organ  are  taken  in  connection  with  the  special  and  general  modifi- 
cation of  function  which  may  be  present  in  individual  cases,  the  greatest 
possible  assistance  is  afforded  us  in  establishing  the  diagnosis.  Thus  it  is 
more  easy  to  detect  cancer  of  the  stomach  than  of  the  lungs,  of  the  latter 
than  of  the  brain;  because  of  our  being  able  to  ascertain  the  presence  of 
the  greater  number  of  the  local  signs  of  the  disease  in  the  first  case,  only 
a  few  of  them  in  the  second  and  none  at  all  in  the  third. 

Further  Diagnosis.— And  when  the  sense  of  sight  can  be  applied  with 
that  of  touch  and  hearing  the  diagnosis  seldom  presents  much  difficulty, 
as  in  the  case  of  carcinoma  of  the  os  uteri  and  rectum.  It  is  necessary  to 
observe  that  too  much  reliance  is  not  to  be  placed  on  the  presence  of  these 
general  symptoms  which  constitute  the  cancerous  cachexia,  for  there  are 
morbid  conditions  of  the  stomach  and  duodenum  associated  with  the  de- 
rangements of  the  biliary  secretion  which  give  rise  to  a  state  of  debility 
and  emaciation,  accompanied  with  discoloration  of  the  skin,  which  so 
closely  resembles  this  cachexia  that  the  one  is  not  to  be  distinguished 
from  the  other. 

Difficulty  of  Diagnosis. — The  difficulty  of  establishing  the  diagnosis  in 
such  cases  is  likewise  increased  by  the  circumstance  that  the  same  chronic 
character  prevails  in  both.  It  is  hardly  necessary  to  remark  that  the  pres- 
ence of  carcinoma  in  an  external  part  of  the  body  is  to  be  regarded  as  a 
diagnostic  sign  of  great  importance  in  all  cases  of  a  doubtful  character 
in  which  functional  derangement  of  an  internal  organ  has  existed  for  some 
time.    In  such  a  case  we  should  regard  the  frequent  occurrence  of  vomit- 


CANCEE,  OK  MALIGNANT  DISEASE.  36C 

ing  after  meals  as  indicating  the  existence  of  carcinoma  of  the  pylorus, 
even  should  no  tumor  be  felt  in  this  situation  or  dilatation  of  the  stomach. 

Abdominal  Tumor. — If  the  presence  of  a  tumor  were  detected  in  any 
part  of  the  abdominal  cavity  we  should  not  hestitate  to  say  that  it  was  of 
the  same  nature  as  the  external  affection,  and  the  occurrence  of  paralysis, 
under  the  same  circumstances,  would  justify  us  in  attributing  it  to  car- 
cinoma of  the  brain  or  spinal  cord. 

Possibility  of  Cure. — In  no  disease  is  a  fatal  determination  so  uni- 
versally admitted  as  in  carcinoma.  The  possibility  of  the  cure  of  cancer 
of  the  internal  organs  has  never  been  supported  by  substantial  evidence, 
and  the  examples  are  few  indeed  in  which  we  are  disposed  to  believe  that 
the  disease  has  been  removed  from  an  external  part  by  surgical  or  other 
means,  without  its  recurrence  in  the  same  or  some  other  part  of  the  body 
at  some  other  future  period. 

Symptoms. — Changes  in  the  color,  temperature,  circulation  and  nutri- 
tion of  the  affected  organ  cannot  be  detected  by  direct  observation,  and 
those  of  bulk  consistence  and  form  can  be  determined  only  in  certain 
organs,  and  at  a  more  or  less  advanced  period  of  the  disease,  such  as  the 
stomach  and  intestines,  liver,  spleen,  kidneys,  ovaries  and  uterus,  lungs 
and  mesenteric  glands,  in  all  of  which  organs  these  changes  may  be  recog- 
nized either  by  the  touch,  percussion^  or  auscultation.  But  it  is  more 
particularly  the  change  of  bulk  which  is  detected  by  these  means,  and 
which,  as  a  local  symptom  of  the  presence  of  cancer,  is  that  to  which  the 
greatest  importance  is  to  be  attached.  The  increase  of  bulk  which  ac- 
companies the  presence  of  cancer  is  not  perceptible  until  the  disease  has 
made  some  progi'ess.  It  is  most  considerable  in  solid  organs,  such  as  the 
liver,  kidney,  ovaries  and  so  forth,  and  is  seldom  very  marked  in  hollow 
organs,  such  as  the  stomach  or  intestines. 

Further  Symptoms — Considerable  increase  of  hvik  may,  however, 
have  taken  j^lace  in  the  walls  of  the  stomach  and  intestines  without  our 
being  able  to  detect  its  presence,  which  happens  when  cancerous  matter 
accumulates  in  the  direction  of  the  internal  surface  of  these  organs.  In 
such  cases  an  increase  of  bulk  of  a  different  kind  is  produced,  viz.,  dilata- 
tion, in  consequence  of  the  obstacle  presented  by  the  carcinomatous  matter 
to  the  passage  of  the  food  or  feces.  When  dilatation  of  the  stomach  is 
thus  produced,  the  obstacle  is  situated  at  the  pylorus;  when  of  the  small 
intestines,  it  is,  in  the  great  majority  of  cases,  situated  at  the  termination 
of  the  duodenum  or  commencement  of  the  jejunum  and  caput  cecum  coli; 
2-i 


370  CONSTITUTIONAL    DISEASES. 

and  at  the  sigmoid  flexure  of  the  colon  and  rectum  when  the  dilatation 
occupies  the  larger  intestines. 

Bulk  of  Stomach. — The  increase  of  bulk  which  the  stomach  and  intes- 
tines acquire  in  consequence  of  an  obstacle  of  this  kind  is  sometimes  very 
great.  In  some  cases  of  scirrhus  pylorus  the  stomach  has  been  found  to 
occupy  the  greater  part  of  the  abdominal  cavity,  stretching  down  to  the 
sjTujjhysis  of  the  pubis  and  from  one  lumbar  region  to  another;  and  the 
large  intestines  sometimes  measure  from  four  to  six  inches  in  diameter 
M'hen  similarly  affected.  We  have  seen  the  small  intestines  equal  in 
size  to  the  ordinary  dimensions  of  the  stomach.  It  is  important  to  know 
that  the  extent  of  the  dilatation  is  not  to  be  taken  as  the  measure  of  the 
extent  of  the  disease.  The  greater  the  dilatation  the  gTcater  we  may 
infer  is  the  obstacle  by  which  it  is  occasioned,  but  this  obstacle  may  con- 
sist in  a  slight  scirrhus  enlargement,  which  prevents  the  passage  of  the 
food  or  feces  as  effectually  as  when  it  is  occasioned  by  one  or  more  tumors 
of  considerable  size  or  great  thickening  occupying  se^'cral  inches  in  length 
of  the  whole  circumference  of  the  walls  of  the  stomach  and  intestines. 

Pain  of  Cancer — The  only  modification  of  the  sensibility  which  as  a 
local  symptom  accompanies  cancer  is  that  of  pain.  There  is,  however,  no 
symptom  of  carcinoma  more  deceptive  than  pain.  Of  all  varieties  of  car- 
cinoma it  is  that  of  scirrhus  which  is  most  frequently  accompanied  vnth 
pain,  and  it  is  also  in  this  variety  that  the  pain  is  most  severe,  acute  and 
lancinating.  Vomiting  is  an  invariable  consequence  of  carcinoma  of  the 
pylorus,  accompanied  with  a  diminution  of  bulk  of  the  orifice  of  this  part 
sufficient  to  interrupt  or  impede  the  exit  of  the  chyme  or  indigested  food. 

Vomiting  in  Cancer — Perhaps  the  most  frequent  cause  of  vomiting  is 
the  mechanical  obstacle  occasioned  by  the  carcinomatous  substance  in  the 
pyloric  portion  of  the  stomach.  The  quantity  and  quality  of  the  matters 
vomited  are  variable.  Both  will  be  modified  by  the  quantity  and  quality 
of  the  food  and  drink ;  the  former  by  the  capacity  of  the  stomach  and  the 
absence  or  presence  of  irritation ;  the  latter  by  the  nature  of  the  iugesta, 
the  state  of  digestion  and  the  stage  and  variety  of  the  disease.  It  is  only 
at  the  early  stage  of  carcinoma,  or  at  least  before  softening  and  ulceration 
have  taken  place,  that  the  vomiting  consists  of  a  watery  or  mucous  secre- 
tion. In  the  great  majority  of  cases,  and  always  toward  the  termination 
of  the  disease,  the  contents  of  the  stomach  ejected  by  vomiting  contain  a 
substance  resembling  the  lees  of  wine,  a  mixture  of  chocolate  or  soot  and 
water.  The  substance  may  appear  in  the  form  of  little  particles,  patches 
or  streaks,  and  indicates  the  effusion  of  the  blood  into  the  cavity  of  the 


CANCER,  OB  MALIGNANT  DISEASE.  371 

stomach  from  hemorrhage,  either  in  consequence  of  the  softening  of  the 
carcinomatous  matter  or  the  sloughing  of  this  suhstance  and  of  the  con- 
tiguous parts. 

Cancer  of  liver — Carcinoma  of  the  liver  may  occur  without  any 
appreciable  derangement  of  the  special  function  of  the  organ  being  ob- 
served. There  is  often  no  apparent  alteration  in  the  quantity  or  quality 
of  the  bile,  even  in  the  most  extensive  forms  of  cancer  of  the  liver. 

Cancer  of  Kidney — There  is  no  apparent  modification  of  the  secre- 
tion of  urine  in  cancer  of  one  of  the  kidneys,  although  the  disease  may  be 
so  extensive  as  to  leave  no  trace  of  the  natural  structure  of  the  organ. 

Cancer  of  Uterus. — The  much  more  frequent  occurrence  of  cancer 
after  than  before  the  cessation  of  the  menstrual  discharge,  prevents  us 
from  estimating  accurately  the  influence  which  this  disease  exercises 
on  the  special  function  of  the  uterus  and  ovaries.  Impregnation,  however, 
has  been  luiown  to  have  taken  place  in  carcinoma  of  the  os  uteri,  and  of 
one  of  the  ovaries. 

Cancer  of  Spleen — As  regards  the  spleen,  its  cellular  organization  may 
be  completely  effaced  by  the  presence  of  the  carcinomatous  matter,  and 
consequently  it  is  rendered  incapable  of  receiving  more  blood  than  is 
necessary  for  the  nutrition  of  its  solid  parts  and  the  growth  of  the  disease. 

Cancer  of  Duodenum — Cancer  of  the  duodenal  extremity  of  the  pan- 
creas, in  consequence  of  the  compression  of  the  duct  which  passes  in  this 
direction,  gives  rise  to  an  accumulation  of  the  secretion  of  this  organ,  and 
great  dilatation  of  the  duct  throughout  its  whole  extent.  Diminished  or 
suspended  absorption  are  the  occasional  consequences  of  cancer  of  the 
mesenteric  and  lymphatic  glands. 

Cancer  of  Brain. — The  functional  lesions  which  accompany  cancer  of 
the  brain,  cerebellum  and  spinal  cord  vary  considerably  with  the  seat  of 
the  disease  relative  to  these  organs  individually,  as  well  as  to  particular 
portions  of  them.  But  in  neither  of  these  respects  does  it  give  rise  to  any 
symptoms  which  can  be  regarded  as  pathognomonic  of  its  presence.  As  a 
foreign  body  it  gives  rise  sometimes  to  a  degree  of  compression  sufficient 
to  produce  partial  or  complete  paralysis,  loss  of  memory  or  difficulty  of 
speech  and  derangement  of  the  intellectual  faculties. 

Symptoms But  these  latter  changes  depend  principally  on  the  irrita- 
tion and  softening  of  the  substance  of  the  brain  in  contact  with  tlie  car- 
cinomatous mass.  Even  paralysis  is  more  frequently  produced  by  these 
subsequent  changes  than  by  compression. 

The  Spinal  Cord. — Paralysis  of  the  superior  and  inferior  extremities 


372  CONSTITUTIONAL   DISEASES. 

of  the  muscles  of  respiration,  and  of  the  bladder  and  rectum  take  place  in 
carcinoma  of  the  spinal  cord,  the  seat  and  extent  of  the  paralysis  depend- 
ing on  the  portion  of  the  spinal  cord  occupied  by  the  disease. 

General  Symptoms. — The  general  symptoms  of  carcinoma  do  not  make 
their  ajipearance  before  the  last  stage  of  the  disease.  Their  severity  de- 
pends much  on  the  nature  of  the  organ  and  the  extent  to  which  it  is  af- 
fected, but  it  is  principally  the  irritation  produced  by  the  presence  of 
the  cancerous  substance  during  the  period  of  softening,  sloughing  and 
ulceration  that  determines  the  gravity  of  these  symptoms.  It  is  in  this, 
the  last  stage  of  the  disease,  that  the  circulation  and  innervation  become 
deranged,  and  that  fever  and  a  diminution  of  the  nutritive  function  are 
first  observed.  It  is  likewise  at  this  period,  but  more  frequently  a  few 
days  or  weeks  before  death,  that  the  skin  assumes  a  pale  earthy  or  dull 
ochrey  tint ;  the  debility  and  emaciation  make  rapid  progress,  and  all  the 
functions  of  the  economy  become  implicated  in  the  deteriorating  influence 
of  the  disease.  It  is  this  group  of  the  general  symptoms  which  constitute 
what  is  called  the  cancerous  cachexia. 

Fever  Symptoms. — The  febrile  symptoms,  as  well  as  the  diminution  of 
nutrition  in  general,  are  greatest  when  the  seat  of  cancer  is  the  uterus  or 
stomach,  and  least  in  those  organs  as  the  brain  and  lungs,  in  the  former  of 
which  softening  and  in  the  latter  compression  may  terminate  in  death 
before  either  of  these  symptoms  has  become  conspicuous.  General  dropsy 
does  not  often  occur  and  is  never  great.  Ascites  frequently  accompanies 
carcinoma  of  the  liver. 

Cancerous  Dropsy. — Dropsy  of  the  inferior  extremities  occurs  more 
frequently  in  cancer  of  the  ovaries  and  uterus  than  of  any  other  organ.  It 
is  the  consequence  of  compression  of  the  iliac  veins,  but  it  may  also  be 
occasioned  by  the  extension  of  the  inilaumiation  -which  accompanies  the 
ulcerative  stage  of  the  disease  to  these  vessels.  Compression  of  the  vena 
cava  by  tumors  in  the  liver,  or  by  the  enlarged  mesenteric  glands,  may 
also  give  rise  to  the  same  state  of  the  inferior  extremities. 

Colloid  Cancer — Colloid  or  alveolar  carcinoma  is  characterized  by  the 
stroma  being  tolerably  thick  and  so  arranged  as  to  divide  the  mass  into  a 
number  of  cystiform  chambers,  or  alveoli,  which  are  occupied  by  a  jelly- 
like substance.  Generally  pale  and  transparent  this  may  be  firm  as  the 
white  of  a  hard-boiled  egg  in  the  older  cells,  or  of  the  consistency  of  half 
dissolved  glue  or  currant  jelly.  In  any  form  it  is  non-adherent  to  the 
walls  of  the  cells,  and  may  be  readily  removed.  The  disease  assumes  two 
forms,  the  circumscribed  and  infiltrated.     The  former  is  met  with  in 


CANCEE.  OK  MALIGNANT  DISEASeT"  373 

subcutaneous  tissue  and  in  the  bones  of  the  extremities,  constituting  the 
osteo-sarcoma  and  spina  ventosa.  The  latter  is  seen  in  the  walls  of  the 
alimentary  canal.  It  is  of  much  slower  growth  than  either  of  the  above 
varieties,  and  rarely  or  never  ulcerates  or  softens. 

Black  Pigment — Melanosis  is  a  form  either  of  scirrhus  or  encephaloid, 
in  which  a  deposit  of  black  pigment  has  taken  place. 

Soft  Cancer — Encephaloid  or  soft  carcinoma  possesses  a  matrix  less 
abundant  and  firm  than  in  the  preceding  variety.  So  deficient  is  this  that 
the  mass  is  of  jelly  or  brain-like  consistency.  Its  cells  are  for  the  most 
part  large,  with  a  tendency  to  assume  the  caudate  form.  The  growth  may 
be  circumscribed  (forming  tumors  often  of  immense  size) ,  or  it  may  occur 
in  the  tissues  as  an  iniiltration.  It  is  elastic,  occasionally  fluctuating  un- 
der jiressure,  as  though  pus  was  present.  "When  opened  it  shows  a 
whitish-yellow  surface,  dotted  with  pinkish  spots  during  life.  It  is  very 
vascular,  giving  a  purplish-red  tinge  to  the  contig-uous  skin  and  possessing 
oftentimes  a  distinct  fruit.  Hemorrhage  resulting  from  the  spontaneous 
rupture  of  some  of  these  vessels  is  not  infrequent,  forming  apoi^lectic  clots 
in  the  interior  if  confined,  but  constituting  frightful  loss  of  blood  if  rup- 
turing the  matrix.  When  ulcerated  the  surface  of  the  tumor  assumes  a 
dark,  sang-uineous  appearance,  in  which  condition  it  is  often  described  as 
fungus  hematodes.  From  the  first  the  peculiar  cancerous  cachexia  is 
better  marked  in  this  than  in  any  other  kind  of  malignant  growth.  Its 
most  frequent  sites  are  the  eye,  cavities  of  face,  articular  ends  of  bones, 
the  testicles,  uteriis  and  breast.     The  disease  runs  its  course  rapidly. 

Skin  Cancer — Epithelioma  or  epithelial  cancer  differs  from  the  above 
in  having  an  imperfectly  defined  matrix  which  possesses  a  tendency  to 
form  concentric  lamluaj  around  the  cellular  elements.  These  are  gen- 
erally mixed  up  with  altered  epithelial  cells  of  the  parts,  and  are  more 
constant  in  their  outline  than  other  cancerous  growths.  Epithelioma  is 
found  chiefly  at  the  margin  of  the  mouth  and  at  the  anus,  though  it  is 
occasionally  seen  on  the  hands  and  feet. 

Cancer  of  Bones Osteoid  cancer  is  defined  as  a  malignant  tumor, 

usually  commencing  in  the  bones,  consisting  almost  entirely  of  bone  and 
followed  by  similar  growths  in  the  glands  and  viscera. 

Membranous  Cancer — Villous  cancer  is  the  name  given  to  cancer  in 
a  mucous  membrane  when  covered  with  a  villous  or  velvet-like  groAvth. 

A  host  of  remedies  have  been  proposed  for  the  cure  of  cancer;  the 
greater  number  of  them  have  been  tried  in  almost  every  form  of  the 


374  CONSTITUTIONAL  DISEASES. 

disease,  but  they  have  nearly  all  failed  to  justify  the  high  praises  bestowed 
on  their  curative  virtues. 

Kemedies. — 1.  The  remedies  which  retard  or  arrest  the  progress  of 
cancer  consist  of  those  which  exercise  a  direct  or  indirect  influence  on  the 
nutritive  function  of  the  affected  organ.  Among  the  former  are  those 
which  operate  directly — the  local  abstraction  of  blood  by  means  of  leeches 
and  compression  hold  the  first  rank.  The  first  of  these  means  should  be 
employed  for  a  considerable  length  of  time,  at  intervals  of  one,  two  or 
three  days,  and  the  quantity  of  blood  taken  should  be  regulated  chiefly  by 
the  strength  of  the  patient.  The  diminution  of  bulk  of  the  original 
tumor  which  follows  this  mode  of  treatment  is  sometimes  very  consider- 
able. 

2.  In  the  great  majority  of  cases  the  tumor  is  not  entirely  removed. 
It  may  be  reduced  from  the  size  of  a  hen's  egg  to  that  of  a  nut,  and 
in  this  state  remain  stationary  for  years  without  giving  rise  to  pain  or 
any  inconvenience  whatever.  The  alternate  use  of  local  bleeding  and 
compression  effect  more  rapidly  the  reduction  of  bulk  just  noticed  than 
when  either  is  employed  separately. 

3.  Although  compression  and  local  bleeding  are  employed  benefi- 
cially they  are  by  no  means  to  be  altogether  relied  upon.  In  consequence 
of  a  modification  of  nutrition  in  general,  and  consequently  of  that  of  the 
affected  organ,  the  beneficial  effects  of  some  general  remedies  in  car- 
cinoma of  external  organs  are  chiefly  to  be  attributed.  Some  of  these 
remedies  appear  to  modify  nutrition  by  effecting  some  unknown  change  in 
the  composition  of  the  blood,  as  aconitum,  couium  and  arsenic ;  others,  by 
acting  on  the  capillary  circulation  and  absorption,  as  mercury,  in  altera- 
tive doses,  and  various  preparations  of  iodine. 

4.  The  beneficial  effects  of  tonics,  as  preparations  of  iron,  the  fixed 
and  volatile  alkalies,  mineral  waters  and  all  other  remedies  which  in- 
crease the  vital  energies,  invigorate  digestion  and  promote  absorption  and 
secretion,  may  also  be  referred  to  a  favorable  change  induced  in  the 
nutritive  function  of  the  affected  organ  by  the  introduction  of  these 
remedies  into  the  circulating  system. 

5.  The  salutary  operation  of  these  local  and  general  remedies  is 
much  increased  by  a  judicious  combination  of  both,  regulated  according 
to  the  circumstances  of  individual  cases. 

Diet. — But  while  employing  any  of  these  remedies  it  is  of  the  utmost 
importance  to  regulate  the  diet  and  regimen  of  the  patient  in  such  a 


CANCER,   OE  MALIGNANT  DISEASE.  375 

manner  that  neither  of  them  may  interfere  with  the  operation  of  the 
remedy  employed. 

Virtues  of  Conium — For  example,  the  curative  virtues  of  coniuni 
depend  greatly  on  the  quantity  of  food  consumed  by  the  patient,  that  is 
to  say,  the  operation  of  this  remedy  is  more  or  less  powerful  when  only  a 
small  quantity  of  food  was  allowed  and  hardly  perceptible  when  the 
quantity  was  considerable. 

The  following  has  been  our  experience  with  the  use  of  conium  in 
this  disease: 

1.  The  patient  takes  a  dose  of  the  extract  of  conium,  morning  and 
evening,  two  hours  before  each  meal.  The  amount  of  the  first  dose  is  half 
a  grain,  which  is  gradually  increased  to  six  grains  each  time.  This  dose 
is  continued  for  about  three  weeks  in  order  that  the  organs  may  become 
habituated  to  its  operation,  and  is  afterward  increased  to  twelve  grains 
each  time,  beyond  which  it  is  not  necessary  to  carry  the  remedy,  because 
of  its  influence  being  sufficient.  The  twelve-grain  dose  is  continued  from 
two  to  four  weeks. 

2.  After  each  dose  of  conium,  as  well  as  at  meals,  the  patient  uses  a 
glass  of  the  decoction  of  sarsaparilla. 

3.  Only  the  third  of  the  ordinary  quantity  of  food  is  allowed,  which 
ought  to  be  very  simple  and  divided  into  three  small  meals. 

4.  If  the  conium  disagrees  in  one  form  it  should  be  given  in  another 
or  the  aconitum  may  be  used  instead,  but  in  lesser  quantity  than  the 
conium.  Toward  the  end  of  the  treatment  the  dose  of  the  conium  is 
gradually  diminished  and  the  diet  gradually  increased. 

Further  Eemedies — The  only  class  of  remedies  which  can  be  expected 
to  afford  any  essential  benefit  are  those  that  are  capable  of  inducing  a 
new  condition  in  the  system  by  modifying  the  function  of  nutrition,  such 
as  the  various  preparations  of  iodine,  combined  with  a  thorough  change 
of  everything  surrounding  the  individual.  The  cachexia  is  the  real  mor- 
bid condition  and  the  cancerous  affections  in  particular  organs  are  but  so 
many  evidences  of  it,  as  tubercles  in  the  lungs  are  mere  expressions  or 
indications  of  another  form  of  cachexia,  equally  possessing  the  whole 
system.  Hence  it  is  that  cancerous  tumors  on  the  external  parts  of  the 
body  are  so  apt  to  recur  after  they  have  been  removed  by  the  surgeon. 

Removal  of  Tumors. — Still  it  must  be  admitted  that  in  cases  of  scir- 
rhus  tumors,  when  they  have  been  removed  early,  there  has  very  fre- 
quently been  no  return  of  the  disease.  In  such  cases  the  cachexia  has  been 
less  strongly  marked  and  time,  apparently,  has  not  been  permitted  for  tlic 


376  CONSTITUTIONAL  DISEASES. 

local  niiseliief  to  Increase  the  morbid  disposition.  It  would  seem,  too,  that 
the  particular  species  of  cancer  influences  the  probability  of  recovery. 
There  are  a  few  examples  of  permanent  recovery  after  the  removal  of 
encephaloid  tumoi-s. 

Remedies  for  Cancerous  Fevers — The  remedies  best  calculated  to  pre- 
vent, remove  or  mitigate  the  local  and  general  effects  of  carcinoma  of 
internal  organs  vary  with  the  nature  of  these  effects  and  the  seat  of  the 
disease.  The  state  of  irritation  and  fever  and  pain,  at  whatever  period  of 
the  disease  they  may  occur,  may  be  greatly  moderated  by  the  use  of 
conium,  aconitum,  ojjium,  hyoscyamus,  the  acetate  or  muriate  of  morphia, 
while  at  the  same  time  the  use  of  all  kinds  of  stimuli  is  to  be  avoided,  par- 
ticularly if  the  digestive  organs  be  the  seat  of  the  disease,  and  the  patient 
himself  kejit  as  much  as  possible  in  a  state  of  quiet  of  body  and  mind. 

Treatment. — When  cessation  of  pain  and  a  return  of  strength  and  ap- 
petite take  place,  treatment  is  suspended  for  a  month.  It  is  then  resumed 
for  two  consecutive  months,  then  suspended  for  two  months,  and  recom- 
menced, continuing  during  a  month.  This  plan  is  pursued  for  at  least 
two  years,  which  by  pursuing  the  patient  is  not  only  greatly  benefited, 
but  frequently  cured. 

Ferruginous  preparations  must  not  be  omitted  when  there  is  great 
anemia  caused  by  profuse  hemorrhage  or  imperfect  nutrition. 

Hemorrhages — Hemorrhages  are  treated  by  rhatamy,  sulphuric  acid 
and  ice.  When  they  have  been  arrested,  and  when  the  pain  is  subdued, 
bitters,  such  as  the  decoction  of  cinchona,  infusion  of  quassia,  or  of  Col- 
umbo  root,  are  given;  sometimes  also  certain  remedies  which  combine 
bitter  with  slightly  purgative  properties,  such  as  rhubarb,  are  used;  and 
finally  the  preparations  of  iron. 

Classes  of  Eemedies — The  only  class  of  remedies  that  can  be  expected 
to  afford  any  essential  benefit  are  those  that  are  capable  of  inducing  a  new 
condition  in  the  system,  by  modifying  the  fimction  of  nutrition,  such  as 
the  various  preparations  of  iodine,  combined  with  a  thorough  change  of 
everything  surrounding  the  individual.  The  cachexia  is  the  real  morbid 
condition,  and  the  cancerous  affections  in  particular  organs  are  but  so 
many  evidences  of  it,  as  tubercles  in  the  lungs  are  mere  expressions  or 
indications  of  another  form  of  cachexia,  equally  possessing  the  whole  sys- 
tem. Hence  it  is  that  cancerous  tumors  on  the  external  parts  of  the  body 
are  so  apt  to  recur  after  they  have  been  removed  by  the  surgeon.  StiU  it 
must  be  admitted  that  in  cases  of  cancerous  tumors,  when  they  have  been 
removed  early,  there  has  been  frequently  no  return  of  the  disease.     In 


CANCER,   OK  MALIGNANT  DISEASE.  377 

such  cases  the  cachexia  has  been  less  strongly  marked,  and  time,  ap- 
jxirently,  has  not  been  permitted  for  the  local  mischief  to  increase  the 
morbid  disposition. 

Mitigation  of  Pain. — When  the  carcinoma  or  cancerous  disease  has 
arrived  at  that  period  when  the  cancerous  cachexia  announces  the  exten- 
sive and  fatal  termination  of  the  disease,  the  efforts  of  the  physician  must 
be  directed  solely  to  the  mitigation  of  the  sufferings  of  the  patient.  If 
this  symptom  were  removed,  there  are  many  cases  in  which  carcinoma 
would  run  a  much  longer  course,  and  give  rise  to  comparatively  little 
functional  derangement. 

Termination  of  Cancer — With  regard  to  the  termination  of  cancerous 
affections  of  the  hollow  organs,  it  takes  place  frequently  in  the  uterus  and 
stomach,  the  rectum  and  urinary  bladder,  the  transverse  arch  of  the  colon 
and  jejunum,  and  the  peritoneum.  The  perforation  of  the  rectum,  blad- 
der and  peritoneuni  is  the  consequence  of  the  extension  of  the  disease  from 
the  uterus ;  that  of  the  transverse  arch  of  the  colon,  the  consequence  of  its 
extension  from  the  stomach. 

If  the  OS  uteri  be  the  seat  of  the  disease  additional  benefit  may  be 
derived  from  the  use  of  leeches  applied  to  this  part,  and  also  sedative  in- 
jections. It  is  only  in  this  latter  situation  that  sloughing  and  ulceration 
can  be  detected,  and  local  remedies  applied  to  remove  some  of  the  dis- 
agreeable effects  of  the  one,  or  retard  the  progress  of  the  other.  Anti- 
septic disinfectants  are  perhaps  the  best  remedies  we  can  employ  in  this 
case,  as  they  not  only  destroy  the  disgusting  odor  which  accompanies  this 
stage  of  the  disease  but  remove  the  putrid  and  in-itatiug  fluids  which  are 
then  discharged.  The  retention  of  the  contents  of  hollow  organs  from 
compression  or  obstruction  is  an  occurrence  to  be  guarded  against  by  regu- 
lating the  quantity  and  quality  of  food,  for  negligence  in  this  respect  may 
be  followed  by  fatal  consequences  if  the  obstacle  be  situated  in  the  in- 
testines. 

Further  General  Treatment The  same  general  treatment  is  applic- 
able to  all  forms  of  cancer.  If  the  growth  be  well  defined,  as  in  carcinoma 
of  the  breast,  of  not  very  long  standing  and  not  involving  neighboring 
l;5anphatic  glands,  it  may  be  remo\'ed,  but  severe  hemorrhage  from  a  large 
encephaloid  cancer  or  the  complication  of  important  structures  in  any 
variety  having  deep  attachments  will  preclude  any  operative  procedure. 
Even  when  extirpated  under  favorable  conditions  it  is  very  apt  to  return, 
eventually  to  destroy  the  patient.  The  removal  of  epithelial  growths  by 
the  knife,  or  their  destruction  by  caustic  applications  before  glandular 


378  CONSTITUTIONAL   DISEASES. 

evolvement  has  supervened,  in  many  instances  may  effect  a  permanent 
eure.  In  the  last  few  years  the  X-ray  has  been  used  in  the  treatment 
of  cancer  with  marked  benefit,  especially  the  external  variety.  In  fact, 
many  cures  are  reported. 

Care  in  Removing  Cancerous  Growths. — ^When  a  cancerous  tumor  has 
been  removed  all  surrouudiug  jjarts  should  be  carefully  examined,  because 
it  is  not  uncommon  to  find  small  cancerous  tubercles  in  the  connective 
tissue,  fascia  or  muscular  sheaths,  which,  if  passed  by  unheeded,  would 
soon  increase  and  give  rise  to  a  recurrent  growth. 

COLLOID. 

Characteristics. — This  new  growth,  formerly  called  colloid  cancer, 
gelatinous  or  gum  cancer,  is  no  longer  considered  to  be  malignant,  in  the 
sense  of  its  having  the  power  to  infect  other  and  distant  portions  of  the 
system.  Its  great  characteristic  is  the  formation  of  a  new  growth  in  the 
large  open  meshes  of  which  it  exists  a  glue-like,  gelatinous,  transparent 
substance  like  half  dissolved  ganu  arable.  This  matter  is  strikingly  trans- 
parent. Greenish-yellow  is  its  predominant  hue.  This  jelly-like  matter 
is  exceedingly  soft;  a  colloid  mass  is,  however,  firm  and  resisting;  al- 
though not  apt  to  be  produced  elsewhere,  these  gi'owths  may  obtain  an 
immense  size  and  even  prove  fatal  by  the  disturbances  which  they  cause 
in  the  system.     Fortunately  they  are  quite  rare  in  this  country. 

LTJPTJS  OR  NOLI  ME  TANGERE. 

Character. — This  is  a  spreading,  tuberculosis  inflammation  of  the 
skin,  usually  of  the  face,  tending  to  destiiictive  ulceration.  Its  name  is 
supposed  to  be  derived  from  a  fancied  resemblance  which  the  sores  left 
in  the  progress  of  the  disease  have  to  the  bite  of  a  wolf. 

Symptoms. — 1.  The  "lupus  erytheniatosus"  occurs  chiefly  upon  the 
face,  and  is  symmetrical;  each  patch  has  Avell-defined  edges  and  a  red, 
scaly  surface  with  small  horny  points  upon  it,  due  to  accumulation  in  the 
dilated  mouths  of  sebaceous  ducts. 

2.  The  "lupus  vulgaris"  has  its  origin  in  a  skin  tubercle,  or  tubercles, 
of  a  flat  form,  fleshy  consistence  and  pink,  shining  appearance,  and  these 
at  times  ulcerate.  This  lupus  ulceration,  when  once  originated,  progresses 
steadily,  destroying  every  tissue  it  attacks,  and  when  it  reaches  the  nose, 
its  favorite  seat,  it  simulates  cancer. 

Treatment — In   the   treatment   of  lupus,    although    the    disease   has 


ELEPHANTIASIS  OE  TRUE  LEPROSY.  379 

probably  a  constitutional  origin  and  requires  tonic  treatment,  both  by 
medicine  and  regimen,  there  is  no  disease  that  derives  more  benefit  from 
local  treatment.  Quinine,  with  vegetable  tonics;  cod-liver  oil  and  iodide 
of  potassium  are  all  useful  in  this  respect.  When  the  ulceration  is  super- 
ficial and  the  skin  is  not  deeply  infiltrated,  the  local  application  of  cod- 
liver  oil  on  lint  and  the  covering  up  of  the  part  with  cotton  to  keep  it 
warm  has  in  some  cases  worked  wonders. 

ELEPHANTIASIS  OR  TRUE  LEPROSY. 

Symptoms — This  is  a  constitutional,  hereditary  affection,  essentially 
chronic  in  its  nature,  showing  itself  mainly  as  shining  tubercles  of  differ- 
ent sizes,  of  a  dusky  red  or  livid  color,  on  the  face,  the  ears  and  often  on 
the  legs,  the  skin  being  thickened,  wrinkled,  rough,  unctuous,  devoid  of 
hair,  and  the  perspiration  from  it  highly  offensive.  After  a  time  there  is 
a  circular  margin  enclosing  the  central  red  part  free  from  scales  and  quite 
resembling  the  irregular  scaliness  of  psoriasis. 

When  the  local  disease  has  reached  its  highest  degree  a  remarkable 
constitutional  affection  appears.  The  patient  then  becomes  very  languid, 
asthmatic,  particularly  at  night  time ;  smothering  fits  seize  him,  he  coughs 
violently  and  spasmodically,  and  spends  the  night  in  perfect  sleepless- 
ness, falling  into  excessive,  colliquative,  clammy  sweats,  which  give  an 
intolerably  fetid  odor.  His  voice  becomes  weaker  and  hoarser,  the  ap- 
petite for  food  and  drink  is  preternaturally  increased,  and  the  temper 
becomes  gloomy.  Finally,  various  nervous  symptoms  arise — fainting, 
convulsions,  paralysis  of  some  parts — and  death  arrives,  preceded  by  the 
highest  degree  of  exhaustion. 

Causes — Its  origin  has  been  ascribed  to  want  of  cleanliness  and  to 
miwholesome  diet,  especially  the  constant  use  of  bad  fish,  to  long-con- 
tinued exposure  to  the  heat  of  a  tropical  sun,  to  dampness  of  situation  or 
occupations  requiring  the  frequent  immersion  of  the  limbs  in  cold  water. 

"Where  Occurs — The  disease  occurs  chiefly  in  warm  climates — Arabia, 
China,  India  and  some  of  the  West  India  Islands. 

Dry  Leprosy In  this  the  wasting  of  the  disease  is  circumscribed,  and 

limited  to  all  the  muscles  of  the  hand.  The  skin  is  thick,  reddened,  and 
completely  anesthetic;  the  fleshy  masses  have  entirely  disappeared,  and 
the  fingers  assume  the  shape  of  claws.  This  disease  rarely  attacks  women. 
It  is  accompanied  with  great  torpor  of  mind  and  sluggishness  of-  body. 
Mental  depression  amounting  to  extreme  melancholy  is  the  natural  con- 


330  COKSTITDTIONAL   DISEASES. 

sequence  of  so  hopeless  a  malady.  Yet  the  general  licalth,  for  a  length  of 
time,  suffers  infinitely  less  than  could  have  been  anticipated,  the  actions 
of  the  respiratory  and  digestive  organs  continue  longer  unaffected,  and 
even  the  cutaneous  functions  are  still  tolerably  performed,  as  is  evidenced 
by  abundant  perspiration. 

Progress  of  the  Disease  is  very  slow,  and  its  termination,  though  it 
may  be  deferred  for  many  years,  is  almost  always  fatal,  the  imfortunate 
patient  being  in  the  meantime  dreadfully  deformed  and  mutilated,  and 
literally  dying  by  inches.  The  patches  spread  slowly  till  the  surface  of 
the  whole  body  may  be  at  length  inflicted,  and  its  sensibility  lost.  There 
is  neither  pain  nor  itching,  and  usually  no  swelling.  After  a  few  months 
the  internal  functions  become  deranged,  the  pulse  gets  very  slow  and 
heavy,  "as  if  moving  through  mud,"  the  bowels  grow  costive,  and  there 
is  much  sluggishness  of  mind,  and  tendency  to  sonmolency.  The  skin 
of  the  extremities  becomes  fissured  and  rough,  and  ulcers  appear  under 
the  metatarsal  or  metacarpal  joints — the  integuments  seeming  to  be 
simply  absorbed — or  sloughing  off  in  successive  layers  of  about  half  an 
inch  in  diameter,  without  any  previous  tumor,  suppuration  or  pain.  A 
serous  discharge  ensues  and  there  is  loss  of  sensation  and  a  tendency  to 
ulceration  and  death  of  the  parts.  In  the  advanced  stage  of  the  disease 
the  eyes  are  fierce  and  staring,  and  the  voice  hoarse  and  nasal. 

Character. — Leprosy  is  not  a  contagious  disease,  but  is  propagated  by 
inheritance,  depending  on  some  specific  taint  transmitted  from  parents 
to  children.  The  two  forms  of  this  horrible  disorder  are  the  tuberculated 
and  the  non-tuberculated  or  anesthetic. 

Treatment — The  only  hope  of  exterminating  this  dreadful  disease 
appears  to  lie  in  the  adoption  of  hygienic  measures  tending  to  improve 
the  general  condition,  both  physical  and  moral,  of  the  leprous  poor. 
Without  this  medical  treatment  is  of  little  or  no  avail,  but,  with  the  aid 
of  improved  sanitary  surroundings,  tonics  and  alteratives,  especially  prep- 
arations of  iron  and  iodine,  have  a  very  beneficial  effect.  Much  may  be 
hoped  also  from  the  systematic  employment  of  baths,  either  saline  or 
sulphureted,  in  this  affection. 

Leprosy  Germ. — A  bacteria  claimed  to  be  the  cause  of  leprosy,  and 
named  the  bacillus  leprar,  was  discovered  in  Norway  in  1874,  and  its 
existence  in  the  tubercles  of  this  disease  has  been  confirmed,  although  its 
causative  power  has  not  yet  been  completely  demonstrated. 
An  internal  and  external  remedy  is  as  follows: 


SCKOFULA.  38l 

Corrosive    sublimate    2  grains 

Bismuth   subnitrate    I   drachm 

Amylum    Vi  drachm 

Arsenious   acid    20  grains 

Cosmoline     i  ounce 

Make  ointment.  Over  a  patch  of  skin  three  or  four  inches 
square  rub  the  ointment  in  well  once  daily  for  about  two  weeks, 
then  treat  a  fresh  portion  until  the  body  is  covered. 


SCROFTILA. 

Causes. — A  blood  disease  manifesting  itself  In  a  great  variety  of 
organs  and  characterized  when  fully  developed  by  the  presence  of  a  pecu- 
liar unorganized  matter  termed  scrofulous.  The  causes  are  chiefly  her- 
editary transmission  and  deprivation  of  pure  air.  It  is  closely  allied  to 
pulmonary  consumption. 

Symptoms. — The  scrofulous  habit,  when  strongly  marked,  is  easily 
recognized.  The  skin  is  usually  delicate  and  irritable ;  the  patient  suffers 
very  readily  from  chilblains,  and  in  childhood  is  more  liable  than  others 
to  cutaneous  diseases.  The  mucous  membranes  partake  the  delicacy  and 
irritability  of  the  skin.  The  edges  of  the  eyelids  are  apt  to  be  red  and 
swollen ;  the  eye  is  very  liable  to  be  attacked  by  inflammations ;  hemor- 
rhages from  the  nose,  cold  in  the  head  and  enlarged  tonsils  are  frequent. 
The  muscles  commonly  want  firmness,  and  the  whole  system  is  deficient 
in  stamina. 

Diagnosis. — Scrofula  is  eminently  a  disease  of  childhood,  while  con- 
sumption belongs  to  a  later  period,  bitt  neither  is  confined  to  any  age. 
One  of  the  forms  in  which  scrofula  most  commonly  and  earliest  shows 
itself  is  swelling  of  the  lymphatic  glands  in  various  parts  of  the  body, 
more  particularly  about  the  neck.  These  become  enlarged  and  firmer, 
and  after  a  time  a  deposition  of  the  peculiar  curd-like  matter  is  found  to 
have  taken  place  in  their  interior.  After  a  time  suppuration  occurs,  the 
swellings  become  softer  and  the  skin  over  them  assumes  a  dusky  red  hue, 
gradually  becomes  thinner  and  finally  bursts,  giving  outlet  to  an  un- 
healthy pus  mixed  with  the  curd-like  deposit  of  the  disease.  The  ulcers 
left  heal  slowly  and  with  difficulty,  and  imless  great  care  is  exercised  pro- 
duce deformed  cicatrices. 

Treatment. — 1.  In  the  constitutional  treatment  of  these  cases  of  stru- 
mous adenitis,  nutritious  food,  suitable  warm  clothing,  attention  to  clean- 
liness and  residence  in  pure  air  are  the  most  important  requisites.  Iodine 
iu  its  different  forms,  especially  the  syrup  of  the  iodide  of  iron,  is  given 


382  CONSTITUTIONAL  DISEASES, 

in  doses  of  twenty-five  drops  thrice  daily,  and  quinine  and  iron  each  in 
gi-ain  doses  three  times  a  day,  with  one-sixtecuth  of  a  grain  of  arsenic,  or 
phosphites  and  hypophosjDhites  of  lime  and  magnesia,  in  tablespoon  doses 
of  the  syrup,  are  frequently  of  great  service.  Also  the  iodide  of  am- 
monium in  three-grain  doses  three  times  a  day. 

2.  In  endeavoring  to  produce  a  reduction  of  the  swollen  glands  by 
causing  an  absorption  of  the  contents,  the  tincture  of  iodine  painted  on 
with  a  camel's-hair  brush,  or  small  feather,  so  as  to  smart  severely  but 
not  to  raise  a  blister,  and  repeated  daily  for  a  week  or  so  until  the  skin 
peels  oif  is  a  valuable  resource.  A  milder  application  of  the  same  remedy 
is  by  the  use  of  the  ointment  of  iodine  rubbed  into  the  skin  over  the  en- 
larged gland,  night  and  morning,  for  weeks  and  even  months  if  requisite. 

3.  Cod-liver  oil  is  an  anti-strumous  remedy  of  great  power,  and  is 
more  readily  taken  by  the  young  than  by  adults;  generally  sea  bathing 
and  sea  air  are  mostly  the  best  of  remedies^ 

Ophthalmia — Strumous  ophthalmia  occurs  in  children  between  the 
time  of  weaning  and  the  end  of  the  ninth  or  tenth  year.  Its  chief  symp- 
toms are  redness  of  the  white  of  the  eye,  with  the  formation  of  little 
blisters  or  pustles,  often  ending  in  minute  ulcers  on  the  cornea  or  clear 
portion.  The  eyes  water  very  freely,  and  the  intolerance  of  light  is  exces- 
sive, so  much  so  as  almost  to  be  indicative  of  the  disease. 

Treatment. — The  management  of  these  cases  will  tax  the  skill  of  both 
nurse  and  doctor  to  the  fullest  extent,  although  internal  remedies  are 
often  also  required,  the  nursing  and  outward  applications  are  the  most 
important.  Great  attention  must  be  paid  to  cleanliness,  and  warm  bath- 
ing of  the  eyes  with  anodyne  fomentations  are  very  serviceable.  Appli- 
cations of  the  wine  of  ojiium  or  of  a  solution  of  nitrate  of  silver,  of  a 
strength  of  from  five  to  ten  gi-ains  in  an  ounce  of  water,  although  they 
smart  severely  at  first  are  often  of  very  great  benefit. 

Diet. — Good  diet  is  indisi^ensable  in  strumous  affections.  Hence  the 
invalid  should  have  all  the  advantages  of  an  abundance  of  good  mutton 
and  beef,  vegetables  and  ripe  fruits  in  season,  raw  eggs,  milk  and  cream, 
tepid  or  cool  baths  and  sea  air. 

PRESCRIPTION  I. 

R. — Cod-liver  oil  and  hypopliosphites   5  ounces 

One  or  two  tablespoonfuls  three  times  a  day. 


EICKETS. 


PRESCRIPTION 


383 


R. — Citrate  of  iron  and  quinine    lo  grains 

Cod-liver    oil    I  ounce 

Glycerine    i 

Take  a  tablespoonful  three  times  a  day. 

RICKETS. 

Causes. — The  cause  of  rickets  seems  to  be  anything  which  induces 
enfeebled  assimilation  of  food  and  impaired  nutrition  of  body.  Hence 
this  affection  is  sometimes  met  with  in  such  weakly  children  of  even 
wealthy  parents  as  suffer  from  defective  action  of  the  vital  forces.  Like 
scrofula,  it  is,  however,  especially  a  disease  of  the  poorer  classes.  Insuffi- 
cient and  especially  improper  food,  the  constant  respiration  of  foul,  im- 
pure air,  residence  in  dark,  damp,  cold  or  filthy  dwellings,  these  and  sim- 
ilar circumstances  readily  serve,  in  all  probability,  to  generate  rickets. 

Symptoms. — This  disease  rarely  appears  before  the  seventh  month, 
and  most  commonly  does  not  declare  itself  until  the  child  first  begins  his 
attempt  to  walk.  "When  a  child  is  about  to  be  affected  with  rickets  he 
becomes  dull  and  languid,  the  appetite  is  variable  and  capricious,  the 
bowels  are  irregular,  the  stools  unhealthy  and  usually  pale.  Constitu- 
tional disturbance  now  arises,  and  a  febrile  state  is  soon  established ;  the 
limbs  become  emaciated ;  the  belly  tumid ;  the  face  full  and  the  head  dis- 
ju-oportiouately  large;  the  forehead  projecting,  and  the  sutures  of  the 
cranium  remaining  open  or  perhaps  expanding  slightly.  The  extremities 
of  the  long  bones  which  are  least  concealed  by  muscle,  as  those  of  the 
wrists  and  ankles,  and  the  sternal  ends  of  the  ribs,  particularly  these  last, 
are  swelled  out  into  knobs.  The  legs  begin  to  bend  outward  at  the  knee, 
giving  rise  to  the  deformity  of  bow-legs,  or  less  frequently  the  knees  are 
thrown  forward  and  the  feet  outward,  making  the  child  what  is  called 
knock-kneed,  and  usually  crippling  it  more  or  less  for  life.  The  bones 
of  the  arms  and  the  collar  bones  may  also  become  very  much  curved  and 
twisted,  showing  that  the  popular  delusion  as  to  the  cause  of  bow-legs  has 
little  foundation  in  fact.  The  deformity  of  the  chest  is  often  very  great, 
the  back  being  flattened,  the  breast  bone  pushed  forward  and  the  natural 
curve  of  the  ribs  lessened.  In  such  cases  the  child  is  said  to  be  pigeon- 
breasted. 

Diagnosis — This,  of  course,  must  be  difficult  in  the  early  stage,  as 
the  symptoms  closely  resemble  scrofula  at  that  time,  but  after  the  curva- 
ture of  the  bones  commences  there  can  no  longer  be  any  doubt,  as  such 
softening  of  the  bones  during  childhood  only  occurs  in  rickets. 


384  •  CONSTITUTIONAL   DISEASES.  , 

Treatment — The  medical  treatment  of  rickets  must  be  subordinate 
to  tlie  hvgieiiic,  since  far  more  depends  upon  good  food,  jiroper  clothing 
and  pure  air  than  on  drug  medication.  Milk  diluted  with  limewater,  Lie- 
big's  food,  and,  if  the;  infant  is  old  enough,  beef  tea,  extl-act  of  beef,  raw 
meat,  eggs,  and  so  forth,  should  be  giveii  in  abundance.  The  phosphates 
or  hypophosphates  of  iron,  lime,  quinine  and  strychnia,  as  recommended 
when  treating  of  scrofula,  are  very  useful,  and  if  the  child  is  capable  of 
digesting  cod-liver  oil  it  ought  also  to  be  administered.  Should  the  diar- 
rhoea be  troublesome  a  chalk  and  soda  mixture,  containing  a  grain  of  each 
as  a  dose  for  a  baby  one  year  old,  or  a  mixture  containing  a  grain  of  bis- 
muth in  each  dose  for  an  infant  of  that  age  "will  probably  be  of  essential 
service,  and  after  the  feverish  symptoms  are  controlled  the  child,  in  suit- 
able weather,  should  almost  live  in  the  open  air,  especially  if  a  seaside 
atmosjjhere  can  bo  obtained. 

Diet. — If  the  disease  has  occurred  at  a  very  early  age  it  may  be 
advisable  to  try  the  effect  of  changing  the  wet-nurse;  and  in  general  it 
will  be  proper  to  wean  the  child  about  the  end  of  the  ninth  month,  for 
protracted  suckling  is  certainly  one  of  the  debilitating  causes  which  dis- 
jiose  to  rickets.  While  the  child  continues  at  the  breast  the  diet  of  the 
nurse  or  mother  ought  to  be  carefully  attended  to,  in  order  that  the  milk 
may  prove  nutritious  and  easy  of  digestion ;  or  its  powers  may  be  assisted 
by  allowing  the  infant,  in  addition,  small  quantities  of  gelatin,  beef  tea, 
or  yolk  of  egg,  provided  the  absence  of  febrile  excitement  will  permit. 
After  the  child  has  been  weaned  the  diet  must  be  suited  to  the  degree  of 
constitutional  irritation  which  exists;  but  one  leading  principle  should 
lie  to  support  the  strength  as  much  as  possible  without  quickening  the 
circulation  or  oppressing  the  stomach. 

CRETINISM. 

Causes. — A  condition  of  persons  in  whom  partial  or  complete  idiocy 
is  combined  with  great  bodily  deformity  of  the  whole  body,  due  to  bad 
water,  lack  of  sunlight,  and  life  in  deep  valleys  like  those  of  the  Alps. 

Symptoms — There  are  three  varieties,  first,  complete  or  incurable 
cretinism,  which  is  characterized  by  idiocy,  deaf-dumbness,  deficiency  of 
general  sensibility  and  entire  absence  of  reproductive  power;  second, 
semi-cretinism,  which  is  a  degree  of  the  malady  in  which  the  mental 
faculties  are  limited  to  the  impressions  of  the  sense  and  the  bodily  wants. 
The  general  sensibility  is  obtuse,  the  head  is  badly  formed  and  drooping. 


DIABETES  OE  DIABETES  MELLITUS.  385 

the  speech  is  rudimentary  and  the  reproductive  powers  are  feeble  or 
absent;  third,  incomplete  or  curable  cretinism,  in  which  the  mental  facul- 
ties, though  limited,  are  capable  of  development. 

Treatment. — 1.  The  first  thing  to  be  accomplished  is  the  removal  of 
the  young  cretin,  as  soon  as  possible  after  the  disease  exhibits  itself,  to  a 
pure,  bracing  atmosjjhere. 

2,  The  treatment  requires  an  abundance  of  pure  water  for  drinking, 
washing  and  bathing;  warm  and  cold  baths  and  douches;  friction  of  the 
skin  with  brushes  and  stimulating  liquids  to  rouse  its  action;  warm 
clothing ;  mineral  tonics ;  nourishing  food ;  iodine,  cod-liver  oil  and  phos- 
phates. The  effort  to  develop  the  mind  must  follow  the  attempt  to  re- 
store the  body  to  a  healthy  condition. 

DIABETES  OH  DIABETES  MELLITTJS. 

Causes — Twice  as  many  men  as  women  have  this  disease :  It  is  most 
frequent  among  young  and  middle-aged  adults;  the  mortality  from  it 
being  greatest  from  fifteen  to  fifty-five.  It  is  more  common  in  cities  and 
manufacturing  districts  than  in  the  open  country;  occasionally  it  is 
hereditary.  The  exciting  causes  appear  to  be  exposure  to  cold  and  wet; 
drinking  cold  water  largely  when  heated;  excessive  use  of  saccharine 
food ;  intemjierance ;  violent  emotion ;  febrile  diseases,  and  organic  affec- 
tions and  injuries  of  the  brain  and  spinal  cord. 

Symptoms. — In  this  remarkable  disease  there  is  an  excessive  discharge 
of  urine  containing  grape-sugar,  the  saccharine  jirinciple  of  grapes  and  of 
honey  called  glucose,  being  produced  in  the  body  in  great  quantity  and 
eliminated  from  the  kidneys.  The  exhaustion,  which  results  from  the 
immense  loss  of  fluid,  sometimes  amounting  to  several  gallons  daily,  is 
often  accompanied  by  other  disturbances  of  the  system  due  to  the  presence 
of  sugar  in  the  other  secretions  and  in  the  blood  and  to  the  modifications 
of  the  nutrition  thus  effected ;  opacity  of  the  crystalline  lens  of  the  eye — 
constituting  diabetic  cataract — is  occasionally  one  of  the  modifications  of 
structure ;  shrinking  of  the  substance  of  the  brain  is  another,  and  a 
peculiar  form  of  inflammation  of  the  lungs  is  another.  It  is  a  disease 
which  commonly,  after  a  longer  or  shorter  course,  proves  fatal. 

Diagnosis — The  detection  of  sugar  in  the  urine,  not  temporarily,  but 
for  a  considerable  time,  is  of  itself  sufficient  to  make  out  the  case. 

ProgTiosis. — ^Recovery  is  not  impossible  in  diabetes,  but  a  large  ma- 
jority  of   cases   end   in   death.      Amelioration — keeping   the   disease   in 
abeyance — is  often  an  attainable  end. 
25 


386  CONSTITDTIONAL   DISEASES, 

Treatment The  most  positive  influence  in  diminishing  the  disease 

belongs  to  opium  or  codoiuii ;  but  this  does  not  n])i)e!ir  to  interfere  with  the 
progress  of  the  disease.  The  alkalies,  pepsin,  iron,  quinine,  salicylate  of 
soda,  alum,  iodine,  nitric  acid,  turpentine  and  the  inhalation  of  oxygen, 
have  all  been  employed. 

Diet. — Since  it  is  found  that  the  amount  of  sugar  discharged  in  the 
urine  fluctuates  very  much  in  accordance  with  the  starchy  and  saccharine 
materials  which  are  eaten,  it  is  the  best  for  the  diet  of  a  diabetic  patient 
to  be  freed,  as  far  as  possible,  from  substances  which  can  be  converted 
into  glucose  by  the  digestive  organs.  Hence  the  effort  should  be,  in 
treating  diabetes,  to  abstain  from  all  starchy  food  as  well  as  from  every 
solid  and  liquid  containing  sugar.  That  meat  and  eggs  may  be  taken,  as 
a  derangement  of  the  liver  is  not  found  to  be  pi'oduced  by  them,  and  fish 
is  a  most  important  article  with  which  to  vary  the  monotony  of  the  diet. 
Skimmed  milk  appears  to  answer  a  very  good  purpose  in  this  disease. 

The  following  prescription  is  of  value  in  diabetes  mellitus: 

R. — Salicylate   of   soda    3       drachms 

Fowler's   solution    i       drachm 

Glycerine    i      ounce 

Water     1V2  ounces 

Mix  and  take  a  teaspoonful  three  times  a  day. 

PUSPURA  OH  LAiro  SCURVY. 

Causes. — It  chiefly  occurs  iu  individuals  of  delicate  habit  or  enfeebled 
by  their  occupations  or  mode  of  life ;  by  confined,  low  or  damp  habitations, 
scanty  food,  hard  labor,  grief,  anxiety,  fatigue  and  watching.  On  the 
other  hand  purpura  frequently  occurs  where  no  causes  of  a  debilitating  or 
depressing  nature  can  be  supposed  to  have  existed. 

Varieties — The  two  varieties  which  are  distinguished  are  the  simple 
and  the  hemorrhagic,  in  the  latter  of  which  the  malady  is  accompanied 
by  bleeding  from  some  of  the  mucous  membranes  of  the  body. 

Symptoms. — ^^"arious  symptoms  denoting  general  disorder  of  the 
system  precede  the  appearance  of  the  spots  in  purpura,  generally  for 
some  weeks.  In  most  instances  languor,  weariness  on  very  slight  exer- 
tion, faintness  and  gnawing  pains  in  the  stomach  are  complained  of.  Tho 
appetite  is  variable,  generally  poor,  but  sometimes  there  is  an  inordinate 
desire  or  craving  for  food.  The  tongue  is  yellowish  and  coated  with  a 
viscid  fur,  the  countenance  sallow  or  dingy,  or  the  face  may  have  a  pale 
and  bloated  appearance  with  swelling  beneath  the  eyelids.     The  purple 


PUEPUEA  OE  LAND  SCUEVT.  387 

spots  usually  appear  upon  the  legs  and  afterward  witliout  any  certain 
order  on  the  thighs,  arms  and  trunk  of  the  body,  and  their  formation  is 
attended  with  great  weakness  and  much  depression  of  spirits.  Deep- 
seated  pains  are  felt  about  the  region  of  tlie  stomach  as  well  as  in  the 
chest  and  loins.  One  of  the  most  distressing  and  dangerous  symptoms  is 
when  the  patient  becomes  of  a  sallow  complexion,  waxy-colored  and  dingy, 
dropsical  swellings  of  the  feet  and  legs  with  deep  and  gangrenous  sores 
appear,  general  dropsy  often  prevails  and  the  sufferer  dies  exhausted. 

Diagnosis. — The  diseases  with  which  purpura  is  most  likely  to  bo 
confounded  are  typhus  fever  attended  with  scurvy.  The  origin  and  course 
of  the  complaint,  the  period  at  which  the  petechise  appear,  the  extent  and 
variety  of  the  accompanying  hemorrhages  will  make  its  diagnosis  clear. 

Treatment — 1.  In  the  treatment  of  this  disease  we  are  not  to  be 
guided  by  the  name  or  external  appearances,  but  by  diligent  attention  to 
the  symptoms  and  especially  to  the  state  of  the  functions  and  the  habit  and 
constitution  of  the  patient.  "Where  high  excitement  prevails  with  strength 
of  pulse  and  vigor  of  constitution,  and  we  have  reason  to  suspect  inflam- 
mation, purging,  with  a  suitable  antiphlogistic  diet,  are  the  appropriate 
remedies. 

2.  Where  a  quite  opposite  state  exists  all  active  depletion  must  be 
abstained  from  and  the  strength  supported  by  beef-tea  and  other  meat 
nutriment;  at  the  same  time  tonics,  such  as  quinine  or  Peruvian  bark,  the 
diluted  mineral  acids  in  five  or  ten-drop  doses,  iron  and  strychnine,  must 
be  administered. 

The  following  offers  a  good  treatment: 

R. — Syrup  of  the  superphosphate  of  iron 1V2  ounces 

Liquor  of  peroxide  of  hydrogen    1V2        " 

Glycerine     '. .  1V2        " 

Water    iVa       " 

Take  a  tablespoonful  three  times  a  day. 


Or, 


R. — Oil   of  turpentine    3       drachms 

Fluid  extract  of  digitaUs    I       drachm 

Mucilage   gum-arabic    1%  ounces 

Peppermint  water    I       ounce 

Make    an   emulsion.      Take    a   teaspoon  ful    every   three 
hours. 


588  CONSTITUTIONAL   DISEASES. 


SCORBUTUS  OR  SCURVY. 


Character. — This  is  a  disease  allied  to  purpura,  but  attended  with  a 
spongy  condition  of  the  gums,  and  livid  patches  under  the  skin  of  consid- 
erable extent,  which  are  harder  than  the  surrounding  structure.  It  has 
been  stigmatized  as  the  great  plague  of  the  ocean,  and  has  been  denomi- 
nated sea  scurvy  to  distinguish  it  from  land  scurvy  or  purpura. 

Causes. — That  the  essential  cause  of  scurvy  is  deprivation  of  fresh 
food,  and,  in  almost  all  cases,  of  fresh  vegetable  food,  is  proved.  Fresh 
meat  will  retard  it  in  the  absence  of  vegetables,  but  neither  this  or  oranges 
and  lemons  will  altogether  prevent  it  through  long  periods.  Additional 
promotive  causes  are  severe  cold,  fatigue,  exposure  and  mental  anxiety  or 
home-sickness. 

Symptoms. — 1.  Languor,  debility  and  lowness  of  spirits  first  occur; 
then  swelling,  sponginess  and  bleeding  of  the  gums;  the  teeth  loosen,  and 
the  breath  is  offensive.  Palpitation  of  the  heart  and  dyspnoea  may  be 
present.  Spots  (from  subcutaneous  extravasation  of  blood)  appear  on  the 
limbs.  Diarrhoea  and  dysentery  often  come  on.  Death  may  take  place 
by  a  gradual  exhaustion  or  by  sudden  syncope. 

2.  A  remarkable  peculiarity  of  scurvy  is  the  readiness  with  which  all 
parts  of  the  body  suffer  from  pressure,  and  the  slightest  possible  blow 
may  produce  an  extensive  bruise,  a  small  eruption  like  flea-bites  is  often 
to  be  seen  on  the  legs,  and  about  the  same  time  the  muscles  of  the  legs  and 
thighs  are  apt  to  become  hard  and  painful,  and  in  a  day  or  two  the  skin 
over  the  painful  part  grows  yellow  and  then  purple.  These  puriile  spots 
may  be  as  large  as  the  palm  of  the  hand  at  first,  and  are  liable  to  extend 
"until  they  cover  half  of  the  limb. 

3.  As  the  disease  advances  all  the  symptoms  become  aggravated.  The 
loss  of  physical  power  increases,  the  purple  spots  have  a  tendency  to 
ulcerate,  and  the  resulting  ulcers  are  especially  distinguished  by  their 
putrid  fungoid  appearance,  and  their  great  tendency  to  bleed. 

Diagnosis — Purpura  hemorrhagica  is  undoubtedly  not  identical  with 
scurvy,  although  "purpuric"  extravasations  are  common  to  both.  Pur- 
pura does  not  depend,  as  scurvy  does  chiefly,  upon  a  fault  of  diet ;  nor  are 
the  gums  affected  in  purpura. 

Treatment — 1.  The  great  remedy  for  scurvy  is  lemon  or  lime  juice ; 
in  seemingly  desperate  eases  the  most  quick  and  sensible  relief  has  been 
obtained  from  lemon  juice,  when  no  other  remedy  seemed  to  avail.  When 
the  acid  operates  violently  upon  the  stomach  and  bowels  of  those  who  are 


ANEMIA. 


389 


much    weakened,    the    addition    of    wine    and    sugar    is    strongly    recom- 
mended. 

2.  A  solution  of  nitrate  of  potash  in  vinegar  has  been  most  advan- 
tageously made  use  of  in  the  proportion  of  one  ounce  of  nitrate  in  one 
quart  of  vinegar,  and  a  tablesjjoonful  of  this  given  two  or  three  times 
a  day. 

3.  Fresh  vegetables  alone  will  restore  what  is  wanting.  Potatoes, 
tomatoes,  oranges  and  lemonade  are  the  most  generally  available  articles. 
If  any  medicine  is  useful  as  an  adjuvant,  it  is  the  tincture  of  the  chloride 
of  iron  in  moderate  doses.  Sometimes  citric  acid  does  good.  For  the 
gums  a  wash  of  tannic  acid  or  tincture  of  myrrh  in  diluted  glycerine  will 
be  useful,  or  alum,  brandy  and  water.  Salt  and  whiskey  rubbing  of  the 
skin  will  aid  in  dissii^ating  the  j^etechiaj. 

Diet — Medical  men  in  charge  of  expeditions  to  a  distance,  for  ordi- 
nary supplies  should  always  insist  on  measures  being  taken  to  furnish 
enough  fresh  vegetables,  or,  next  best,  dessicated  potatoes ;  after  the  latter 
onions,  tomatoes,  turnips,  and  so  forth,  and  oranges  and  lemons  rank. 
Wine  is  also  decidedly  though  not  infalliby  anti-scorbutic. 

The  following  is  a  good  anti-scurvy  remedy : 

R. — Common  salt   lo  scruples 

Chlorate  of  potash   %  ounce 

Rochelle    salts     5  scruples 

Phosphate  of  soda   3  scruples 

Lemon  juice    6  ounces 

Syrup  of  lemon    14  ounces 

Water    7  pints 

To  be  used  as  a  drink  several  times  a  day. 

ANEMIA. 

Causes — Poverty  of  blood.  This  is  a  special,  morbid  state,  in  which 
there  ia  fullness  of  the  surface  of  the  body  and  deficiency  of  the  red 
corpuscles  of  the  blood.  It  is  a  common  affection  among  women,  and  per- 
sons of  both  sexes  who  are  ill-fed,  or  from  any  cause  badly  nourished,  in 
crowded  localities.  It  is  occasioned  by  loss  of  blood,  from  disease  or  injury 
causing  hemorrhage,  from  excessive  suckling  in  a  mother  or  wet-nurse, 
severe  or  protracted  diarrhcea,  or  (more  rarely)  leucorrhea,  typhoid  or 
other  forms  of  fever;  the  malarial  influence,  sustained  for  a  considerable 
time ;  deficiency  of  food,  light,  warmth,  or  fresh  air. 

Symptoms — The  face,  the  hands,  and  the  general  surface  are  pallid 
and  slightly  waxen  or  icteroid  in  their  hue.     There  are  vertigo,  faintish- 


390  CONSTITUTIONAL   DISEASES. 

ness,  palpitation  and  an  impaired  action  of  tlic  organs  generally,  espociallj 
of  the  stomach  and  bowels;  digestion  being  deranged,  with  flatulency, 
constiijation,  and  so  fortL 

Diagnosis — This  is  very  much  aided  by  the  detection  of  various  mur- 
murs, as  the  watery  blood  passes  through  the  heart  and  larger  veins. 
The  jugular  veins  of  the  neck  are  often  the  seat  of  a  well-marked  venous 
hum  in  profound  anemia. 

Treatment — 1.  In  almost  all  cases  it  is  essential  to  put  the  patient  on 
nourishing  diet,  and  esj^ecially  where  the  anemia  has  been  caused  by  im- 
perfect nourishment ;  yet  care  must  be  taken  in  the  very  impressible  con- 
dition of  the  system  which  exists  in  these  cases,  that  undue  excitement  be 
not  induced. 

2.  Our  first  effort  should  be  to  supply  the  materials  for  enriching  the 
blood,  and  especially  those  which  are  necessary  to  construct  the  red  cor^DUS- 
cles,  a  deficiency  of  which  appears  to  be  the  essential  element  in  this 
malady.  Iron,  which  enters  into  their  constitution  more  abundantly 
than  of  any  other  tissues  of  the  body,  is  hence  obviously  called  for,  and 
should  be  administered  in  -nhatever  form  can  best  be  assimilated.  Where 
it  is  well  tolerated  there  is  probably  no  better  preparation  than  tincture 
of  the  chloride  of  iron,  in  twenty-drop  doses  three  times  daily, 

3.  In  cases  where  the  tincture  of  the  chloride  of  iron  is  not  applic- 
able, or  is  objected  to  by  the  patient,  the  powdered  iron,  called  also  iron 
reduced  by  hydrogen,  in  doses  of  a  grain  thrice  daily,  can  almost  always 
bo  borne,  and  is  frequently  of  the  greatest  service.  All  the  compoimds 
of  iron  require,  however,  to  be  used  for  a  long  time,  usually  several 
■weeks  and  often  for  several  months,  in  order  to  cure  the  anemic  condition. 

4.  The  citrate  of  iron  or  the  citrate  of  iron  and  quinine,  in  doses  of 
from  three  to  five  grains,  possesses  one' great  advantage  over  many  other 
preparations  of  this  useful  metal  in  the  fact  that  while  perfectly  soluble 
they  produce  iipon  the  organs  of  taste  little  of  that  styptic  or  ink-like  im- 
pression which  to  many  persons  is  so  exceedingly  disagreeable.  The  beef, 
wine  and  iron  is  also  a  most  valuable  remedial  agent  when  properly  pre- 
pared. 

Diet — The  best  food  which  the  stomach  can  digest,  and  there  is  no 
doubt  that  the  iron  which  exists  in  beef  and  mutton  and  gives  much  of  its 
red  color  to  the  muscular  fibres  of  the  flesh,  is  in  the  most  favorable  state 
for  assimilation  into  the  human  system,  and  often  has  a  large  share  in  the 
improvement  which  we  are  perhaps  too  ready  to  attribute  to  the  chemical 
compounds  prescribed. 


GENEEAI.  DROPS Y.  391 

R. — Corrosive   sublimate    2  grains 

Liquor  of  chloride  of  arsenic    i  drachm 

Diluted    hydrochloric    acid    Mi  ounce 

Tincture  chloride  of  iron   V2  ounce 

'Syrup    3  ounces 

Water    2  ounces 

Take  a  dessertspoonful  in  a  wineglass  of  water  after 
each  meal. 

BERI-BERI. 

This  is  a  very  fatal  but  obscure  disease  occurring  in  Ceylon,  the 
Malabar  coast  and  outer  ports  of  British  India. 

Causes — The  causes  are  very  obscure.  It  is  a  disease  of  debility, 
arising  from  a  want  of  stimulating  and  nourishing  diet,  impure  air  and 
exposure  to  a  moist  and  marshy  atmosphere  while  the  frame  is  debilitated 
by  residence  in  an  unhealthy  station. 

Symptoms — It  commences  with  the  symptoms  of  anemia  and  pro- 
ceeds to  the  development  of  acute  dropsy. 

Diagnosis — The  paralytic  symptoms,  together  with  the  dyspnoea  and 
dropsical  effusions  are  suiEcient  to  distinguish  it  from  other  diseases.  In 
no  disease  is  internal  congestion  so  strongly  marked,  doubtlessly  due  to 
the  congestion  of  blood  in  the  brain  and  spinal  marrow. 

Treatment — 1.  Mercury  here  appears  to  be  the  sheet-anchor,  but  must 
be  administered  to  produce  ptyalism.  Saline  and  antimonial  medicines 
will  be  called  for  and  the  strength  supported  by  cordial  liquors.  Stimu- 
lating liniments  should  be  applied  to  the  extremities  and  a  tonic  plan  of 
treatment  pursued. 

2.  In  the  more  severe  cases  where  the  dyspnoea,  vomiting,  spasms 
and  other  symptoms  are  violent  apply  blisters  to  the  breast,  hot  fomenta- 
tions and  hot  baths,  and  exhibit  the  strongest  cordials  and  antispasmodics. 

R. — Muriate   of  pilocarpine    3  grains 

Water     V2  ounce 

Inject  10  to  20  minims  with  hypodermic  syringe. 

GENEEAL  DROPSY. 

Definition. — A  morbid  collection  of  fluid  in  one  or  more  of  the  serous 
cavities  within  the  body  or  in  the  areolar  tissue  beneath  the  skin  and  in 
other  situations. 

Causes — A  dropsical  accumulation  is  to  be  distinguished  from  the 
eiTusion  of  liquid  which  takes  place  in  certain  inflammatory  diseases, 


392  CONSTITUTIONAL  DISEASES. 

pleurisy,  jjeritonitis,  pericarditis,  and  so  forth.  In  other  diseases  the 
effusion  is  due  to  inflammation,  whereas  in  dropsy  transudation  takes  place 
intact,  the  part  where  it  occurs  being  inflamed. 

Local  Dropsy — Dropsy  may  he  local  or  general.  It  is  local  when  the 
effusion  of  liquid  is  confined  to  a  single  serous  cavity  or  to  the  areolar 
tissue  within  a  limited  space. 

General  Dropsy — Dropsy  is  said  to  he  general  when  effusion  into  tfce 
areolar  tissue  beneath  the  skin  exists  more  or  less  over  the  whole  body, 
accompanied  with  effusion  into  certain  serous  cavities,  especially  the 
pleural  and  peritoneal. 

Symptoms. — The  symptoms  of  dropsy  vary  somewhat,  according  to 
the  primary  disturbance  which  has  been  the  original  cause  of  the  effusion. 
If  the  blood  is  deteriorated  by  an  undue  proportion  of  water  or  is  charged 
with  excrementitious  materials,  such  as  urea,  which  ought  to  be  eliminated 
by  the  kidneys  in  the  urine,  or  contains  a  large  excess  of  white  corpuscles, 
its  circulation  through  the  capillary  vessels  is  much  impeded.  The  dropsy 
in  these  cases  often  begins  in  the  form  of  cedema  or  swelling  about  the 
feet  and  ankles.  The  rej^roduetive  organs  often  become  enormously 
swollen  and  ascites  or  dropsy  of  the  abdomen  soon  sets  in.  After  a  time 
the  increasing  ascites,  by  pressing  up  the  diaphragm,  interferes  with  the 
respiration,  causing  distressing  dyspnoea,  which  is  more  urgent  in  pro- 
jiortion  as  the  blood  is  watery  from  anemia.  The  urine  is  often  scanty 
and  apt  to  contain  an  excess  of  urates,  but  it  is  only  markedly  albuminous 
when,  as  frequently  happens,  the  kidneys  become  secondarily  implicated. 
Among  the  latter  sjTnptoms  are  palpitation  of  the  heart,  deficient  perspira- 
tion, mental  distress,  thirst,  constipation,  daily  increasing  weakness,  and 
so  forth. 

Symptoms  of  Cardiac  Dropsy — ^Disease  of  the  mitral  or  aortic  valves 
in  the  heart  is  the  most  common  cause  of  cardiac  dropsy.  The  injured 
valve,  sooner  or  later,  interferes  so  much  with  the  circulation  that  serious 
disturbances  become  manifest.  At  first,  perhaps,  there  is  only  shortness 
of  breath  on  going  up  a  steep  flight  of  stairs,  or  other  active  exertion, 
with  some  palpitation  and  debility,  but  after  a  few  weeks  or  months  the 
feet  and  ankles  may  begin  to  swell,  the  skin  putting  on  a  peculiar  white 
and  glistening  appearance.  As  the  effusion  extends  upward  rest  in  the 
recumbent  posture  becomes  impossible,  and  even  in  the  sitting  position 
only  unrefreshing  snatches  of  slumber  can  be  obtained.  The  heart's 
action  grows  daily  more  and  more  embarrassed,  the  lungs  more  or  less 


GENEEAL    DKOPSY.  303 

congested  and  a  frothy  expectoration  sometimes  streaked  with  blood 
appears. 

Further  Symptoms. — In  the  variety  of  general  dropsy,  which  proceeds 
from  disease  of  the  liver,  serous  effusion  into  the  cavity  of  the  abdomen 
is  the  most  prominent  symptom.  Whether  the  original  hepatic  disorder 
is  congestion  or  hypertrophy  of  the  liver,  cancer,  contraction  or  chronic 
hepatic  inflammation,  the  dropsical  symptoms  usually  commence  with 
exudation  of  fluid  into  the  abdominal  cavity  from  the  surface  of  its  lining 
membrance,  the  peritoneum.  Dropsy  of  the  feet  and  legs,  however,  sub- 
sequently sets  in. 

Acute  General  Dropsy — Acute  general  dropsy  from  disease  of  the 
kidneys,  or  acute  inflammatory  dropsy  may  arise  when  the  functions  of  the 
skin  are  suddenly  suppressed,  thus  allowing  certain  morbid  materials  to 
accumulate  in  the  blood  and  to  set  up  inflammation  in  the  secreting 
tubes  of  the  kidneys.  Typical  examples  of  this  form  of  dropsy  are  seen 
when,  from  exposure  to  cold,  the  action  of  the  skin  is  checked  during  the 
stage  of  desquamation  of  scarlet  fever,  compelling  the  kidneys  to  remove 
the  scarlatinal  poison  from  the  system  when  it  seems  to  be  particularly 
obnoxious  to  the  renal  tissues.  In  such  cases  the  urine  either  gradually 
br  all  at  once  becomes  scanty,  dark  brown  in  color,  and  on  being  tested 
by  boiling  is  found  to  be  loaded  with  albumen. 

Diagnosis. — The  diagnosis  of  dropsy  is  usually  made  with  ease,  by  the 
fact  that  the  indentation  produced  ou  firm  pressure  with  the  finger  upon 
the  enlarged  foot  remains  for  a  minute  or  so  before  it  is  filled  up  by 
return  of  the  watery  fluid  into  the  connective  tissue.  This  evidence  of  the 
existence  of  dropsy  is  most  conclusively  obtained  when  the  test  is  applied 
over  some  bone  which  naturally  lies  only  a  little  way  beneath  the  skin, 
as  for  example,  the  breast-bone  or  the  shin-bone. 

Treatment. — 1.  The  treatment  of  dropsy,  either  local  or  general,  in- 
volves measures  indicated  by  the  diseases  which  stand  in  a  causative  rela- 
tion to  the  dropsy.  Exclusive  of  these  indications  it  is  often  an  object  of 
treatment  to  effect  either  removal  or  diminution  of  the  dropsical  accumu- 
lation. Remedies  which  produce  watery  evacuations  from  the  bowels,  and 
those  which  increase  the  secretion  of  urine  are  chiefly  relied  upon  for  this. 

2.  The  liquid  in  serous  cavities  may  be  removed  by  a  pimcture  or  an 
incision,  an  operation  called  paracentesis,  or,  commonly,  tapping.  In  some 
cases  of  dropsy  of  the  chest  paracentesis  is  resorted  to.  Tapping  of  the 
abdomen  is  often  employed,  and  is  in  many  cases  useful,  not  only  by 
relieving  suffering  but  promoting  recovery. 


B94I  CONSTITUTIONAL  DISEASES. 

3.  In  cases  of  general  oedema  or  anasarca,  if  the  effusion  be  very- 
large,  great  relief  is  sometimes  obtained  by  minute  punctures  of  the  lower 
limbs,  through  which  the  serum  drains  away  in  abundance. 

4.  "Where  the  acute  general  dropsy  is  dependent  upon  suppression  of 
the  action  of  the  skin  and  kidneys,  active  purgation  and  the  use  of  diuret- 
ics are  to  be  employed.  Jalap  and  cream  of  tartar  (ten  grains  of  the 
former  with  three  drachms  of  the  latter)  every  day  or  two  will  answer 
well  for  catharsis.  A  strong  cathartic  is  croton-oil.  The  dose  is  a  single 
drop,  and  this  will  operate  in  many  instances  most  violently,  producing 
within  half  an  hour  sickness,  vomiting  and  profuse  alvine  evacuations. 

iDiuretics — The  diuretics  most  satisfactory  are  the  infusion  of  juniper 
berries  (a  pint  daily),  acetate  of  potash,  citrate  of  jjotash,  squills  and 
sweet  spirits  of  nitre.  Colchicum  is  perhaps  the  most  powerful  of 
remedies,  and  we  have  succeeded  with  it  in  conjunction  with  mercurials 
in  acting  upon  the  kidneys  in  hepatic  disease  when  no  other  remedy  had 
any  effect.  Tonics,  anodynes,  and  so  forth,  may,  in  visceral  dropsy,  be  of 
more  importance  than  diuretics.  Of  course  it  is  desirable  to  lessen  the  ac- 
cumulation of  fluid,  but  the  effects  of  the  remedies  used  must  be  carefully 
observed,  and  one  symptom  must  not  be  allowed  to  overshadow  all  the 
rest. 

Diet. — In  general  dropsy  attention  to  the  diet  is  very  important  and 
efforts  should  be  made  to  restrict  the  patient  to  the  smallest  amount  of 
fluid  with  which  he  can  sustain  life  comfortably.  With  respect  to  the 
nicer  question  of  food,  dry  articles  of  food  should  be  selected.  It  must 
be  varied  with  tlie  nature  of  the  dropsy  and  the  symptoms  with  which 
it  is  attended,  and  whoever  imderstands  the  meaning  of  a  phlogistic  (in- 
flaunnatory)  and  antiphlogistic  (opposed  to  inflammation)  regimen  will 
know  how  to  apply  either  of  these,  or  to  vary  from  one  to  the  other,  as 
circumstances  may  require. 

For  general  dropsy: 

R. — Powdered  jalap    20  grains 

Cream  of  tartar    3  drachms 

Powdered    ginger    5  grains 

To  be  taken  at  one  dose  before  breakfast,  two  or  three 
times  a  week. 

Dropsy  of  kidneys: 

R. — Tincture    digitalis    I  drachm 

Infusion  of  buchu   4  ounces 

Water     4  ounces 

Take  a  teaspoon  ful  every  three  hours. 


BEIQHT'S  DISEASE.  395 


Heart  dropsy: 


R. — Strychina    Sulpli i  grains 

Bascham's   Mixture 4  ounces 

Two  tcaspooufuls  3   times  a   day. 

BRIGHT'S  DISEASE. 

AlbTiminuria,  dependent  upon  structural  cliange  in  the  kidneys,  or 
to  speak  more  correctly,  disease  of  the  kidney,  characterized  by  albumen 
and  dropsy. 

Causes. — It  is  a  glandular  disease  of  the  cortical  part  of  the  kidney 
which  gives  occasion  to  the  secretion  of  urine,  Avhich  contains  albumen 
and  is  of  less  specific  gravity  than  natural,  and  which  destroys  by  induc- 
ing other  diseases.  It  is  one-third  more  common  in  males  than  in  females. 
It  mostly  occurs  between  the  ages  of  forty-five  and  sixty-five.  Acute 
Bright's  disease  is  most  often  produced  by  cold  and  damj^uess,  next  by 
scarlet  fever,  pregnancy,  or  violent  intemperance.  The  chronic  form  is 
greatly  promoted  by  exposure  to  cold  and  wet,  and  is  caused  moreover  by 
abuse  of  spirituous  liquors.  Other  predisposing  causes  are  gout,  consti- 
tutional syphilis  and  affection  of  the  bladder  and  urethra. 

Acute  Bright's  Disease. — After  exposure  to  cold,  or  a  drunken  fit,  or 
scarlet  fever,  the  patient  is  seized  with  chilliness,  headache,  nausea,  vomit- 
ing, pain  in  the  back  and  limbs,  checking  of  perspiration  and  oppression  in 
breathing.  Fever  follows  and  the  face,  trunk  and  limbs  become  puffy 
with  anasarca.  Effusion  may  also  occur  in  the  pleura  or  peritoneum. 
The  urine  is  scanty,  heavy  and  dark  in  color  from  the  presence  of  blood 
and  very  albuminous.  The  disposition  to  void  it  occurs  more  frequently 
than  in  health.  The  deposit  from  it,  under  the  microscope,  shows  blood- 
corpuscles,  loose  renal  epithelium,  tube-casts  and  shapeless  masses  of  fibrin. 
After  one,  two  or  three  weeks,  or  even  a  longer  period,  the  attack  pro- 
ceeds to  one  of  three  terminations:  recovery,  death  or  lajise  into  the 
chronic  state.  Death  residts  through  uremia,  secondary  pneumonia, 
pleurisy,  peritonitis,  hydrocephalus  or  ascites.  Probably  two-thirds  or 
more  of  the  cases  in  the  acute  form  recover. 

Treatment — Cupping  the  loins,  hot  water  or  hot  air  or  "blanket 
bath,"  active  purging,  as  with  cream  of  tartar  and  jalap,  or  citrate  of 
magnesium  and  diaphoretics,  as  citrate  of  potash  or  liquor  ammonia 
acetatis. 

Diet — Should  be  liquid  and  simply  nutritious. 

Chronic  Bright's  Disease — This  approaches  so  slowly  as  seldom  to  be 


396  CONSTITUTIONAL  DISEASES. 

detected  until  after  the  lapse  of  months  or  years.  Gradual  loss  of 
strength,  pallor  or  pufEness  of  the  face,  shortness  of  breath  and  frequent 
disposition  to  urinate  are  early  signs  of  it.  But  they  are  not  always 
present ;  the  denouement  of  the  disease  may  be  by  a  convulsion,  oedema 
of  the  lungs,  dinuiess  of  vision,  or  some  violent  local  inflammation. 

Symptoms. — Albuminous  urine,  deposits  of  tube-easts  and  renal 
epithelium,  dryness  of  skin,  frequent  micturition,  especiallj'  at  night ;  gen- 
eral dropsy,  or  local  effusions  into  the  cavities,  indigestion,  anemia,  uremic 
effects  (headache,  dizziness  of  sight,  convulsions,  coma,  vomiting,  diar- 
rhoea), enlargement  of  the  heart  and  secondary  inflammations,  bronchitis 
is  especially  common.  The  progi'ess  of  the  case  is  usually  interrupted  by 
exacerbations  and  intervals;  each  fresh  attack  leaving  the  patient  mani- 
festly worse  than  before. 

Diagnosis. — The  presence  of  albumen  in  the  urine,  with  dropsy,  not 
of  sudden  origin  or  brief  duration,  is  indicative  of  this  affection.  The 
microscope  will  show  also  free  renal  epithelium  and  tubular  casts  in  the 
urine;  in  advanced  cases  the  casts  are  sjirinkled  with  oil-dots. 

Treatment. — 1.  Iron  will  do  more  good  than  any  other  medicine,  un- 
less it  be  cod-liver  oil  in  persons  of  strong  stomach.  They  may  be  very 
Avell  combined.  The  tincture  of  the  chloride  of  iron  is  as  good  as  any 
other  chalybeate  as  a  general  rule.  AYith  some  the  citrate  of  iron  in  solu- 
tion, or  a  carbonate,  or  the  iodide,  will  agree  more  readily.  As  an 
astringent  the  ammonio-ferric  alum  is  claimed  to  possess  the  power  of 
checking  the  waste  of  albumen  through  the  kidneys. 

2.  For  the  dropsy  warm  baths  and  hydrogogue  cathartics  are  useful. 
Of  the  latter  cream  of  tartar  and  jalap,  two-  or  three  drachms  of  the 
bitartrate  with  ten  or  twenty  grains  of  jalap  two  or  three  times  a  week, 
are  the  favorites.  If  serious  di'ojisical  accumulations  threaten  life,  elate- 
rium  (one-sixth  or  one-fourth  grain  every  four  hours,  in  pill,  until  it  acts) 
may  be  given,  or  the  pill  of  squills,  powdered  digitalis,  etc. 

3.  If  the  warm  baths  do  not  agree  or  fail  to  produce  diaphoresis  try 
the  hot-air  bath,  at  130  degrees  to  150  degrees  Fahrenheit.  This  rarely 
fails  to  produce  free  perspiration.  For  weaker  invalids  the  vapor  bath 
is  available.  Of  diuretics,  acetate  of  potassium,  spirits  of  nitrous  ether, 
and  compound  si:)irit  of  juniper  Avill  be  least  likely  to  disappoint, 

4.  But  all  will  not  unfrequently  fail.  We  have  as  a  last  resource  for 
the  relief  of  great  oedema  the  use  of  incisions  with  a  lancet  or  needle  in  the 
swollen  legs  and  feet.     Care  should  be  taken  that  erysipelas  does  not  fol- 


UREMIC   POISONING.  397 

low,  bj  repeated  warm  sponging  of  the  limbs  and  washing  them  with 
diluted  glycerine. 

Diet — Nourishing  diet,  of  which  milk  may  generally  be  part,  is  of 
the  utmost  consequence.  Regimen  or  hygienic  management  is  of  the 
utmost  importance.  Avoidance  of  exposure  to  cold,  wet  or  great  fatigue ; 
the  reform  of  intemperance,  if  it  has  existed,  or  all  other  excesses,  will 
be  indespensable.  Clothing  should  be  sufficiently  warm,  with  flannel  next 
to  the  skin.  Bathing  frequently  at  such  temperature  as  is  borne  without 
either  chill  or  relaxation,  and  the  bowels  should  be  kept  regularly  open. 

The  following  are  approved  remedies : 

R. — Chloride  of  soda  and  gold  3  grains 

Corrosive   sublimate 3  grains 

Extract  of  gentian  sufficient  to  make  6o  pills. 
Take  one  three  times  a  day. 

R. — Iodide  of  soda    •. IS  grains 

Phosphate  of  soda  Vj  drachm 

Common    salt    3  drachms 

Water  sufficient  to  make  solution. 

Divide  into  three  equal  parts,  and  take  one  part  every 
eight  hours. 


UREMIC  POISONING  (UREMIA). 

Ursemic  poisoning  (urspmia)  is  also  known  as  acute  uraemia,  urgeinia 
convulsions,  ursemic  intoxication  and  uremic  coma,  according  to  attending 
conditions.  It  may  be  described  as  a  group  of  nervous  phenomena  which 
sometimes  develop  during  the  course  of  acute  or  chronic  Bright's  disease, 
being  due  to  the  retention  in  the  blood  of  what  is  supposed  to  be  urea. 
An  attack  of  acute  ura?mla  is  always  serious.  The  outcome  depends  upon 
the  amount  of  jioison  retained,  the  length  of  time  it  has  been  in  the 
system  and  the  condition  of  the  organs  of  elimination.  If  there  be  any 
suspicion  of  an  ursemic  condition  the  urine  should  be  frequently  examined. 

Causes. — Suppression  of  urine  due  to  Bright's  disease,  cancerous 
kidney,  the  puerperal  or  lying-in  state,  operations  on  the  uterus,  bladder, 
reetmn,  etc.,  or  any  condition  causing  the  failure  of  the  kidneys  to  properly 
perform  their  functions. 

Symptoms. — TTsually  before  the  attack  there  is  a  decrease  in  urinary 
secretions,  although  in  rare  instances,  during  or  immediately  prior  to 
the  appearance  of  the  uraimic  phenomena,  the  normal  flow  of  urine  may 


398  CONSTITUTIONAL  DISEASES. 

largely  exceed  the  normal  amount.  Commonly  the  onset  is  with  headache, 
dizziness  of  vision,  vertigo,  deafness,  dilated  and  sluggish  pupils,  dark, 
uunatiiral  color  of  face.  There  is  generally  a  chill  or  chilliness  followed 
by  fever,  but  there  may  be  cool  skin  from  the  onset.  The  condition  may 
develop  slowly  and  gradually  or  it  may  come  on  suddenly  by  convulsive 
seizure  followed  by  coma.  In  the  latter  case  it  is  sometimes  mistaken  for 
apoplexy,  but  these  differences  are  to  be  noted:  (a)  In  uraemia  the  patient 
has  usually  been  suffering  from  dropsy,  while  this  is  not  common  in 
apoplexy ;  (b)  in  ura?mia  coma  is  generally  preceded  by  the  symptoms 
above  discribed,  while  in  apoplexy  coma  is  usually  immediate;  (c)  the 
breathing  in  urafmic  coma  causes  a  sharp,  hissing  sound,  while  in  apoplexy 
there  is  snoring;  (d)  greater  or  less  paralysis  always  occurs  with  apoplexy 
while  in  urn?mia  there  is  no  paralysis. 

Treatment. — During  an  attack  elimination  should  be  procured  by  a 
drop  or  two  of  croton  oil  in  a  little  sweet  oil,  or  a  quarter  grain  of  elaterin, 
or  the  following  enema  may  be  used ; 

Epsom  Salts   2  ounces 

Glycerine 1  ounce 

Hot  Water 4  ounces 

Free  sweating  should  be  encouraged  by  the  use  of  hot  packs,  vapor  or 
hot-air  baths  and  the  administration  of  Jaborandi.  To  relieve  the  con- 
vulsions give  inhalations  of  chloroform,  rectum  injections  of  chloral  and 
venesection. 


PART  III  OF  BOOK  IV 

Describes   the   nervous   diseases   and    their    causes, 
symptoms,  diagnoses,  treatments  and  effects. 


Aphasia    423 

Symptoms   of    423 

Treatment  of   426 

Apoplexy   422 

Congestive   422 

Hemorrhagic    423 

Symptoms  of   422 

Treatment   of    423 

Arachnitis     416 

Prevention  of  416 

Atrophy  of  the  Brain 426 

Treatment   of    427 

Atrophy,  Progressive  Muscular  ....431 

Brain,  Atrophy  of  426 

Congestion   420 

Dropsy  of  421 

Fever   409 

Fever,  Symptoms  of  409 

Hypertrophy  of  426 

Paralysis  of    404 

Softening  of 401 

Catalepsy    439 

Cerebral  Congestion  420 

Cerebritis    413 

Convalescence  in   420 

General    414 

Suppressed  Menstruation  in   ...420 

Symptoms   of    413 

Treatment  of  416 

Chorea    438 

Chronic  Meningitis   412 

Congestion,  Cerebral   420 

Congestive  Apoplexy  422 

Convulsions,  Infantile    435 

Cramp,  Writer's  428 

Croup,  Causes  of  437 

Spasmodic    437 

Symptoms  of   438 

Treatment  of 438 

Delirium  Tremens 443 

Symptoms  of  443 


Treatment  of 443 

Dementia   446 

Diphtheritic  Paralysis   430 

Symptoms  of 430 

Treatment  of  430 

Dropsy  of  the  Brain  421 

Symptoms  of 421 

Treatment  of   421 

Epilepsy    436 

Symptoms  of  436 

Treatment  of 437 

Face,  Paralysis  of  404 

Facial  Palsy   427 

Symptoms  of   427 

Treatment  of 428 

Falling  Sickness  436 

F'ts   435 

Symptoms  of   435 

Treatment  of  435 

General  Cerebritis   414 

Symptoms   of    414 

Heat   Exhaustion    426 

Symptoms  of 426 

Treatment  of 426 

Hemicrania   441 

Hemiplegia   428 

Symptoms  of 428 

Treatment  of   428 

Hemorrhagic  Apoplexy   423 

Hydrocephalus    421 

Hydrophobia   433 

Symptoms  of 434 

Treatment  of    434 

Hypertrophy  of  the   Brain 426 

Treatment  of  427 

Hypochondriasis    439 

Hysteria    439 

Symptoms  of 439 

Treatment  of  . . .  : 439 

Hysterical  Paralysis   429 

Symptoms  of 429 


399 


400 


INDEX  TO  I'AilT  III  OF   BOOK  IV. 


Treatment  of  429 

Idiocy    447 

Imbecility   447 

Infantile  Convulsions  43s 

Paralysis   431 

Symptoms  of   431 

Treatment  of 431 

Inflammation  of  the  Brain  413 

of  the  Spinal  Marrow 421 

Insanity    444 

Symptoms  of   445 

Treatment  of 447 

Intercostal  Neuralgia  441 

Lead  Palsy   430 

Locomotor  Ataxia    431 

Symptoms  of   431 

Treatment  of   431 

Lock-Jaw    432 

Symptoms  of  432 

Treatment  of 433 

Loss  of  Memory   404 

of  Speech  423 

^Madness   444 

Mania    446 

Symptoms   of   446 

Treatment   of    446 

Alelancholia    445 

IMemory,  Loss  of  404 

Meningitis,   Chronic    412 

Spinal   421 

Mercurial  Palsy   430 

]\Iigraine    441 

Symptoms  of 441 

Muscular  Atrophy   431 

Myelitis    421 

Nervous  Diseases   401 

Neuralgia   440 

Intercostal    441 

Symptoms  of 440 

Treatment  of 442 

Neurasthenia    447 

Symptoms  of 447 

Treatment  of 448 

Palsy   427 


Facial    427 

Lead   430 

Mercurial 430 

Scrivener's   431 

Symptoms   of    427 

Wasting   432 

Paralysis   427 

Agitans    430 

of  the  Brain 404 

Diphtheritic   430 

Face    404 

Hysterical    429 

Infantile   431 

Reflex   429 

Syphilitic    430 

Paraplegia   428 

Symptoms  of 429 

Treatment  of   429 

Progressive   Muscular   Atrophy 431 

Rabies   433 

Rgflex  Paralysis  429 

Treatment  of 429 

St.  Vitus'  Dance 438 

Symptoms  of  438 

Treatment   of    438 

Sciatica    441 

Scrivener's  Palsy   431 

Symptoms  of    431 

Treatment  of  432 

Softening  of  the  Brain   401 

Symptoms   of    403 

Treatment  of 405 

Spasm  of  the   Glottis    437 

Spasmodic    Croup    437 

Spinal  Meningitis   421 

Treatment  of 422 

Sun  Stroke    426 

Symptoms  of  426 

Treatment  of 426 

Syphilitic  Paralysis   430 

Tetanus    432 

Wasting  Palsy 432 

Wrist  Drop   430 

W^riter's  Cramp  428 


ILLUSTRATIONS 


Brain,  The   407 

Face,  Nerves  of  441 


Nerves,  The   425 

Nerves  of  Side  of  Face 441 


CURATIVE  MEDICINE 


PAET in 
NERVOUS  DISEASES 

Division  of  Nerves. — 1.  Motor  nerves  or  those  in  which  irritation  pro- 
duces muscular  contraction. 

2.  Sensitive  nerves,  or  nerves  of  common  sensibility,  in  which  irri- 
tation is  followed  by  an  agreeable  or  painful  feeling,  according  to  the 
nature  or  degree  of  the  stimulation. 

3.  Nerves  of  special  sense  in  which  irritation  excites  the  peculiar 
sensations  of  light,  sound,  taste,  etc.  Many  sensitive  nerves  arise  from 
nervous  centres  in  such  close  proximity  to  motor  nerves  that  a  stimulus 
applied  to  the  former  will  react  upon  the  latter  and  produce  not  only  a 
'direct  sensation,  but  what  is  technically  called  a  reflex  action.  It  is  a 
remarkable  fact  that  whatever  part  of  a  sensitive  nerve  be  irritated, 
whether  it  be  the  centre,  the  middle,  or  the  extremity,  the  same  sensation 
will  be  produced. 

Nature  of  Nervous  Force — We  can  judge  of  the  nature  of  the  nervous 
force  only  by  its  effects.  The  muscular  contraction  caused  by  the  irrita- 
tion of  a  nerve  is  due  to  the  development  of  a  peculiar  vital  force  in  the 
nerve  structure,  which  is  imlike  any  of  the  known  physical  forces.  It 
bears  certain  analogies  to  electricity. 

1.  The  identity  of  their  effects  on  muscular  fibre. 

2.  The  rapidity  of  their  action  without  producing  any  appreciable 
effect  on  the  parts  between  the  point  of  irritation  and  the  point  affected. 

3.  The  extreme  sensibility  of  nerves  to  the  electric  current. 

4.  The  phenomena  of  electrical  fishes. 

SOFTENING  OF  THE  BRAIN  (RamoUissement) . 

Peculiarity. — It  is  the  consequence  of  chronic  or  acute  inflammation, 
or  it  may  occur  from  obliteration  of  the  arteries. 

Softening  of  the  mucous  membrane  of  the  digestive  organs  is  of  much 
more  frequent  occurrence  than  softening  of  the  brain. 
26  (401) 


402  KEKVOITS  DISEASES. 

Causes. — Two  causes  appear  to  cooperate  in  producing  softening  of 
the  brain.  The  first  is  of  a  mechanical,  the  second  of  a  physiological 
nature,  serosity,  or  pus,  when  in  considerable  quantity,  appear  to  effect, 
mechanically,  a  diminution  of  the  cohesion  of  the  tissue  in  Avhich  they  are 
contained.  The  pressure  ■which  they  exercise  arrests  the  circulation,  and 
it  would  appear  absorption  also;  for  if  this  function  were  performed  we 
should  have  an  excavation  or  ulcer  formed  instead  of  a  mass  of  soft,  pulpy 
tissue.  The  circulation  being  thus  arrested  nutrition  ceases  to  be  accom- 
plished and  the  molecules  of  the  tissues  are  disunited  and  detached.  If 
while  these  changes  are  going  on,  or  at  some  subsequent  period,  the  func- 
tions of  absorption  be  resumed,  the  softened  tissue  is  partially  or  wholly 
absorbed  and  solutions  of  continuity  of  various  extent  are  formed.  The 
physiological  cause,  therefore,  of  softening  is  referable  to  a  change  in  the 
vital  properties  of  the  affected  tissue. 

iDegree  of  Softening. — The  degi-ee  of  softening  of  the  cerebral  sub- 
stance may  vary  from  a  slight  diminution  of  the  natural  consistence  of  the 
part  to  that  of  cream  or  even  of  thin  milk.  The  first  stage  of  softening  of 
this  substance  is  often  so  slight  that  it  is  hardly  perceptible  to  the  touch, 
and  may,  even  when  considerable,  if  not  accompanied  by  some  peculiarity 
of  color,  be  altogether  overlooked. 

Physical  Characters. — The  color  of  inflammatory  softening  of  the 
cerebral  substance  presents  considerable  variety,  dependent  on  the 
quantity  of  blood  contained  in  the  affected  part.  Eedness  and  vascularity 
are,  in  general,  greater  in  the  first  than  in  the  second  stage,  but  the  degree 
and  extent  of  either  greatly  depend  on  the  qiiantity  of  blood  in  the 
cerebral  vascular  system.  When  the  redness  which  accompanies  softening 
arises  from  the  presence  of  effused  blood  it  may  always  be  regarded  as 
evidence  that  the  softening  is  of  recent  occurrence. 

Other  Evidences  of  Softening — But  there  are  other  modifications  of 
color  which  accompany  softening  of  the  cerebral  substance.  They  indicate 
that  the  disease  has  existed  for  a  considerable  time,  several  weeks,  or  two 
or  three  months.  The  principal  modifications  of  color  consist  of  brown, 
yellow  and  orange,  either  separately  or  combined,  and  occupy  either  the 
softened  substance,  the  part  of  the  brain  contiguous  to  it,  or  both  at 
the  same  time.  They  are  not  observed  unless  the  softening  has  been 
c-'-ompanied  by  effusion  and  originate  in  changes  taking  place  in  the 
eltused  blood. 

When  Softening  May  Occnr — Softening  may  occur  in  the  brain  and 
medullary  substances  at  the  same  time.     It  may  also  occupy  several  por- 


SOFTENING   OF   THE   BKAIN.  -iOS 

tions  of  the  brain  at  the  same  time,  as  the  septum  lucldiim,  fornix  and 
walls  of  the  lateral  ventricles,  the  corpora  striata  and  thalami,  one  or  more 
lobes,  a  portion  of  one  or  both  hemispheres,  the  brain  and  cerebellum,  and 
is  rarely  met  Avith  in  the  latter  organ  without  its  being  present  in  the 
former.  Circumstances  which  give  great  variety  and  complexity  to  the 
functional  derangement  by  which  it  is  accompanied. 

Symptoms. — As  the  symptoms  of  the  first  period  of  inflammatory  soft- 
ening of  the  brain  must  necessarily  be  those  of  inflammation  of  this  organ, 
it  would  be  superfluous  to  describe  them  here.  It  may,  however,  be 
observed  that  the  severity  of  these  symptoms  does  not  always  indicate  a 
corresponding  condition  as  to  the  extent  of  the  softening  which  they  pre- 
cede, nor  do  they  present  any  one  character  which  can  be  regarded  as  a 
sign  that  the  inflammation  on  which  they  depend  will  terminate  in  soften- 
ing. When,  however,  they  are  taken  in  conjunction  with  those  of  the 
second  period,  they  are  frequently  of  great  value  as  they  afford  us  the 
means  of  establishing  our  diagnosis  in  cases  where  it  would  be  otherwise 
impossible. 

Symptoms  of  Second  Period — The  symptoms  of  the  second  period  of 
inflammatory  softening  of  the  brain  are  of  an  entirely  opposite  character 
to  those  of  the  first  period.  Those  of  the  first  de2:iending  on  the  presence 
of  irritation,  or  a  morbid  stimulus,  are  characterized  by  a  state  of  excite- 
ment; whereas  those  of  the  second  being  the  consequence  of  the  soften- 
ing or  disorganization  of  the  cerebral  substance,  are  necessarily  marked 
by  a  state  of  prostration,  collapse  or  paralysis.  They  are  annoimced  by 
the  gradual  or  sudden  diminution  of  the  intellectual  powers,  by  the  occur- 
rence of  stupor  or  coma,  by  paralysis,  difficulty  or  loss  of  speech  and 
diminution  of  the  sensibility  of  the  skin,  eye  and  ear.  The  relative  fre- 
quency, degree  and  extent  of  these  symptoms,  as  well  as  the  order  of  their 
occurrence,  present  considerable  variety.  Thus,  the  derangement  of  the 
intellectual  faculties,  such  as  their  dirainiition,  suspension  or  abolition,  is 
always  present  at  the  commencement  of  the  second  period,  that  is  so  soon 
as  the  softening  of  the  cerebral  substance  has  taken  place.  In  some  cases 
the  derangement  Avhich  they  manifest  is  at  first  slight,  increases  gradually 
or  rapidly  and  terminates  in  their  entire  abolition.  In  others  these  facul- 
ties are,  from  the  commencement,  gravely  compromised  and  give  no  signs 
whatever  of  their  existence. 

Peculiar  Symptoms — It  is  not  rare  to  meet  with  eases  in  which  their 
dorangomeut  is  marked  by  remissions  and  exacerbations,  or  the  occurrence 
of  lucid   intervals  succeeded  by   ]n-ofound   stupor.      The  delirium  which 


404:  NEEVOTIS  DISEASES. 

accompanies  tlie  first  period  of  inflammatory  softening  either  disappears 
or  diminishes  greatly  in  intensity  when  the  second  period  is  announced 
by  the  derangement  of  the  intellectual  faculties  to  which  we  have  alluded. 
It  diminishes  with  the  diminution  of  these  faculties  and  ceases  when  their 
suspension  or  abolition  is  indicated  by  the  presence  of  coma  and  complete 
paralysis. 

Loss  of  Memory. — ^An  imperfect  state  or  the  entire  loss  of  memory 
and  speech  are  necessary  consequences  of  these  latter  conditions  of  the 
intellectual  faculties.  But  the  absence  of  any  derangement  of  these  facul- 
ties is  not  necessarily  imaccompanied  by  derangement  of  memory  and 
speech,  particularly  the  latter,  for  a  patient  may  recover  the  consciousness 
of  his  existence,  perceive  and  comprehend  what  is  passing  aroimd  him,  and 
yet  be  incapable  of  expressing  himself  in  words  on  account  of  jjaralysis 
of  the  muscles  by  means  of  which  the  act  of  speech  is  accomplished.  The 
diminution,  suspension  or  abolition  of  the  intellectual  functions  are  always 
accompanied  with  paralysis  of  the  muscles  of  voluntary  motion,  and  the 
degree  of  the  paralysis  is,  generally,  in  the  direct  ratio  of  the  extent  of  the 
derangement  manifested  by  these  functions. 

Brain  Paralysis. — The  paralysis  is  rarely  complete  at  the  commence- 
ment. It  is  generally  progressive  with  occasional  alternations  of  increase 
and  decrease  before  it  becomes  ultimately  complete.  The  situation  and 
extent  of  the  paralysis  present  considerable  variety  and  in  many  cases 
seem  to  correspond  with  the  situation  and  extent  of  the  softening,  in  the 
same  manner  as  in  apoplexy.  The  paralysis  occupies  one  or  both  extremi- 
ties of  the  same  side  when  the  softening  is  limited  to  one  of  the  hemis- 
pheres of  the  brain,  and  paraplegia  or  universal  paralysis  is  produced  when 
both  hemispheres,  the  pons  varolii,  etc.,  are  the  seat  of  this  lesion. 
Paralysis  occurs  more  frequently  in  the  superior  than  in  the  inferior 
extremlticG ;  the  seat  of  the  lesion  of  the  former  being  in  the  corpus 
striatum,  and  of  the  latter,  the  optic  thalamus  of  the  opposite  side  of  the 
brain. 

Paralysis  of  Face  Muscles. — Paralysis  of  the  muscles  of  the  face,  of 
the  eye,  of  the  touguo  and  of  deglutition,  depends  likewise  in  the  situation 
of  the  softening.  Paralysis  of  the  bladder  and  rectum  is  a  frequent  occur- 
rence of  softening  of  the  brain,  and  gives  rise,  in  the  first  place,  to  an 
accumulation  of  the  contents  of  these  organs,  and  afterward  to  their  in- 
voluntary escape,  more  particularly  of  the  urine,  from  the  distension  of 
the  bladder  and  the  subsequent  dilatation  of  its  sphincter.  It  is  under 
similar  circumstances  of  the  brain  that  the  organs  of  hearing  and  of  sight, 


SOFTENING    OF   THE   BEAIN.  i05 

■whicli  in  the  first  inflammatory  jicriod  of  softening  are  highly  susceptible, 
are  rendered  obtuse  to  a  degree  that  a  strong  light  or  loud  sounds  im- 
pressed on  the  eye  and  ear  jiass  unjDerceived. 

Permanent  Muscular  Contraction — One  of  the  most  constant  symptoms 
of  inflammatory  softening  of  the  brain  is  a  state  of  permanent  contraction 
of  the  flexor  muscles  of  the  extremities. 

The  last  symptom  which  we  shall  notice  is  that  of  pain.  This  does 
not  depend  on  the  state  of  softening  of  the  cerebral  substance.  It  is  the 
consequence  of  irritation  or  morbid  excitement  of  the  brain,  the  dis- 
organization of  which  has  not  yet  taken  place.  It  is  generally  most  severe 
when  it  occurs  as  a  precursory  symptom,  but  it  frequently  accompanies 
the  first  period  of  the  disease,  and  presents  remission  and  exacerbations, 
variable  in  duration  and  degree. 

Treatment. — There  are  no  successful  eases  recorded  of  softening  from 
obliteration  of  the  arteries,  and  in  the  few  cases  of  the  inflammatory  forms 
of  the  disease,  which  have  terminated  favorably,  it  is  more  than  probable 
that  the  softening  was  very  limited  in  extent  and  affected  the  superficial 
or  less  important  parts  of  the  brain.  As  regards  the  state  of  softening, 
which,  in  point  of  fact,  consists  in  a  solution  of  continuity  of  the  cerebral 
substance,  it  must  be  obvious  that  we  possess  no  remedial  agent  capable  of 
obviating  such  a  change.  The  diseased  state,  therefore,  of  which  we  are 
treating,  is  incurable ;  that  is  to  say,  the  solution  of  continuity  of  which  it 
consists  will  remain,  even  though  the  patient  should  recover.  The  essen- 
tial part  of  the  treatment  of  softening  of  the  brain  relates,  consequently, 
to  the  local  morbid  conditions  which  immediately  precede  tliis  change, 
viz. :  the  diseased  state  of  the  arteries  on  the  one  hand  and  inflammation 
of  the  brain  on  the  other.  This  state  of  the  arteries,  like  the  softening 
to  which  it  gives  rise,  is,  so  far  as  we  yet  know,  beyond  the  control  of 
remedial  agents.  When,  therefore,  it  is  ascertained  that  the  softening  is 
the  consequence  of  this  state  of  the  arteries,  the  only  hope  that  can  be 
indulged  is  partial  relief,  and  the  prolongation  of  life  for  a  short  period 
beyond  that  at  which  the  disease  would  have  proved  fatal  had  it  been 
allowed  to  run  its  natural  course. 

Staying  Treatment — It  is  possible  that  the  attack  may  be  delayed  by 
judicious  treatment,  employed  when  the  first  symptoms  of  cerebral  de- 
rangement are  perceived,  such  as  pain  in  a  particular  part  of  the  head, 
confusion  of  ideas,  giddiness  or  unusual  drowsiness  and  listlessness,  to- 
.•^otlier  with  a  prickling  sensation  or  uujnbness  in  the  muscles  of  the  ex- 
tremilie?,  face  or  tongue. 


406 


NERVOUS    DISEASES. 


THE  BEAIR 


Figure  No.  i. 
1,1,1,1.     Motor    track    delineated    from 
the    front    columns    of    the 
spinal  marrow  to  the  hemi- 
spheric  ganglion. 

2.  Pyramidal  body. 

3.  Eminences  in  the  medulla  ob- 

longata. 

4.  Variolus  bridge. 

5.  Legs  of  the  brain. 

6.  Streaked  body. 

7.  Hemispheric  ganglion. 

8.  Cerebellum. 

9.  Olfactory  nerve. 

10.  Optic  nerve. 

11.  Fourth   pair   of  nerves. 

12.  Sensory  root  of  the  fifth  pair. 

13.  The  seventh  and  eighth  pairs 

of  nerves. 

14.  Front  suture. 

15.  Mammillary  elevation. 

16.  Corpora   geniculatum. 
Figure  No.  2. 

I,  I.     Section  of  the  callous  bod}-. 

2.  Transparent  partition. 

3.  Front   column   of   the   vault. 

4.  Section  of  front  suture. 

5.  Central      substance      of      the 

chamber. 

6.  Sylvius'  aqueduct. 

7.  Pineal  gland. 

8.  Medullar  band  which  extends 

from  the  pineal  gland  to  the 
front   suture. 

9.  Section    of    the    legs    of    the 

brain. 

10.  One   of  the   white  bodies,   or 

mammillary  bodies. 

11.  Gray  excrescence. 

12.  Section  of  the  intricacy  of  the 

optic  nerves. 

13.  Optic  nerve  beyond  the  intri- 

cac}'. 

14.  Olfactory  nerve. 

15.  Front    surface    of    the    hemi- 

sphere. 

16.  Fissure  between  the  back  and 

middle    lobes   of   the  brain. 
Figure  No.  3. 

1.  Front  extremity  of  the  fissure 

of  the  brain. 

2.  Back  extremity. 

3.  Front  lobes  of  the  brain. 

4.  Middle  lobe. 

5.  The  Sylvius  fissure. 

6.  Back  lobe. 

7.  Infundibulus  point. 

8.  Its  body. 

9.  White  or  mammillary  bodies. 

10.  Ash-colored  matter. 

11.  Legs  of  the  brain. 

12.  Variolus'   bridge. 

13.  Upper  end  of  the  medulla  ob- 

longata. 


14.  Back  prolongation  of  the  va- 

riolus bridge. 

15.  Middle  of  the  cerebellum. 

16.  Front  part. 

17.  Back  part. 

18.  Upper  part  of  the  .spinal  mar- 

row. 

19.  Middle  fissure  of  medulla  ob- 

longata. 

20.  Pyramidal  body. 

21.  Recti  form  body. 

22.  Oval  body. 

23.  Olfactory  nerve. 

24.  Its  bulb. 

25.  Its  external  root. 

26.  Its   middle  root. 

27.  Its  internal  root. 

28.  Optic  nerve  beyond  the  intri- 

cacy. 

29.  The  same  before  the  intricacy. 

30.  Motor  of  the  eye  or  third  pair. 

31.  Pathetic  nerves  or  fourth  pair. 

32.  Trigeminus  or  fourth  pair. 

33.  External  motor  or  sixth  pair. 

34.  Facial   nerve. 

35.  Auditive   nerve. 
3*^.37.38.     Eighth  pair. 
Figure  No.  4. 

•    I.    Vertical  section  of  the  head. 

2.  Frontal  cavity. 

3.  Greater  falcc  of  the  brain. 

4     Its   origin    from   the   rooster's 
comb. 

5.  Its    union    along    the    sagital 

suture. 

6.  Lender  or  concave  edge. 

7.  Counteraction     to     the     cere- 

bellum store. 

8.  Cerebellum   store. 

9.  Union  to  temporal  bone. 

10.  Free  edge   of   same. 

11.  Tortuous     elevations     of     the 

front     right     lobe     of     the 
brain. 

12.  Front  extremity  of  the  callous 

body. 

13.  Transparent  partition. 

14.  Section  of  the  front  suture. 

15.  Front  parts  of  the  vault. 

16.  The  middle  of  same. 

17.  Back  end. 

18.  Inner  side  of  the  bed. 

19.  Section   of    streaked  bodies. 

20.  Side   walls   of  the   third  ven- 

tricle. 

21.  The  dura  mater,  turned  upside 

down. 

22.  Section  of  the  internal  car- 

otid artery. 
Figure  No.  5. 

1.  Front  lobe  of  the  brain. 

2.  Back  lobe. 

3.  Middle  lobe. 


Fia.  1.— View  of  the  course  of  the  front 
columns  of  the  spinal  marrow  turminatiug 
iu  the  hemispheric  ganglions  of  the  brain. 


Fig.  2.— Middle  vertical  section  of  tho 
callous  body.  The  inner  left  side  of  the 
brain  is  also  seen. 


Fig.  3. — View  of  the  base  of  the  bruin  and  ceiebel- 
lum,  together  with  the  nervea. 

ISKq 


Fig.  4.— Section  of  the  head  showing  the  greater 
scythe,  the  horizontal  apophysis  of  the  diameter 
between  the  brain  and  the  cerebelhun  and  other 
oarts  found  under  the  middle  Hue  of  the  head. 


Pkj-  5. — View  of  tiie  appearance  of  the  ttirtnoua 
elevations  of  one  side  of  the  brain,  seen  from  above. 


THF  BRAIN. 


For  an  explanation  f»f  the  illualrallun^  Kee  text  on  opposite  page 


Wt 


408  NERVOUS  DISEASES. 

Further  Treatment. — Bleodiiig  fi'oiu  the  temples,  cupping  in  the  nape 
of  the  ucc'k,  or  small  general  bleedings,  repeated  from  time  to  time  as  cir- 
cumstances may  require,  may,  by  diminishing  the  quantity  of  the  blood, 
facilitate  the  circulation  of  this  fluid  through  the  brain.  But,  perhaps, 
the  greater  advantage  would  be  derived  by  keeping  the  bowels  freely  open 
without  inducing  excitement  or  debility,  chiefly  by  means  of  the  neutral 
salts.  The  compound  aloetic  pill  will  be  advantageously  employed  in 
those  cases  in  which  the  disease  occurs  after  the  cessation  of  the  cata- 
menia,  or  suppression  of  a  hemorrhoidal  discharge.  A  diminution  of  the 
circulating  fluids,  as  well  as  their  equalization,  will  be  effected  likewise 
by  promoting  all  the  secretions,  particularly  those  of  the  urine  and  bile. 

iDiet — The  food  and  drink  of  the  patient  should  be  particularly 
attended  to.  His  diet  should  consist  of  those  kinds  of  food  which  are 
most  easily  digested,  and  which  afford  the  greatest  quantity  of  nourish- 
ment in  the  smallest  bulk.  Ardent  spirits,  strong  wines,  fermented  liquors, 
even  strong  coffee  or  tea  and  all  stimulants  should  be  avoided  as  more  or 
less  injurious. 

Treatment  of  Second  Period — The  treatment  of  the  second  period,  or 
that  of  softening  from  inflammation,  is  the  same  in  principle  as  that  of 
the  former,  in  so  far  as  it  regards  the  state  of  excitement  with  which  this 
morbid  change  is  generally  accompanied;  But  if  the  paralysis  be  fairly 
established  and,  notwithstanding  the  depletory  and  sedative  measures 
which  have  been  employed,  continues  to  increase,  neither  our  own  ob- 
servation nor  the  recorded  experience  of  others  would  recommend  a  steady 
perseverance  in  the  means,  the  debilitating  effects  of  which  have  not 
been  sufficient  to  overcome  the  inflammatory  excitement  of  the  first  period. 
Bleeding  and  active  purgatives  should  now  be  laid  aside;  blisters  or 
sinapism  should  be  ajJijlied  to  the  inferior  extremities,  the  nape  of  the 
neck  and  superior  part  of  the  spine ;  the  head  should  be  kept  cool  by  the 
constant  application  of  evaporating  lotions ;  the  bowels  evacuated  once  or 
twice  a  day  by  means  of  a  mild  aperient,  or  by  injections,  the  secretion 
of  urine  and  the  cutaneous  perspiration  should  also  be  promoted  by 
remedies  of  the  least  stimulating  qualities.  The  retention  of  the  urine  is 
a  complication  which  must  l^e  sedulously  watched,  that  this  fluid  may  be 
removed  before  it  accumulates  to  a  degree  to  prove  injurious;  stimuli  or 
tonics  should  now  be  employed  with  a  view  to  support  the  strength  of 
the  patient,  but  they  ought  never  to  be  employed  to  such  an  extent  as  to 
produce  excitenuuit,  as  the  powers  of  life  are  already  greatly  exhausted 
by  the  stimulus  of  the  disease. 


BEAIN  FEVEE.  !409 

BRAIN  FEVER. 

(Cerebral  Macula.) 

Difficult  Diagnosis. — Under  tliis  term  we  propose  to  include  the  path- 
ology, symptoms  and  treatment  of  the  inflammatory  affections  of  the  brain 
and  of  its  membranes.  We  adopt  this  plan,  not  merely  because  of  the 
intimate  relation  subsisting  between  these  structui'es,  but  because  when 
we  trace  the  history  of  a  number  of  acute  affections  of  the  encephalon  and 
examine  the  lesions  of  structure  presented  after  death,  we  shall  frequently 
find  that  the  substance  of  the  organ,  as  well  as  the  investing  membranes, 
has  been  involved  in  the  disease.  Hence  arises  the  difficulty  of  establish- 
ing the  diagnosis  between  inflammation  of  the  parenchyma  of  the  brain 
and  that  of  its  membranes. 

Symptoms. — When  either  the  arachnoid  or  pia  mater,  which  closely 
invest  the  brain,  are  extensively  inflamed,  the  functions  of  this  oi'gan 
become  inevitably  disturbed  by  sympathetic  irritation,  without  its  paren- 
chyma necessarily  partaking  of  the  inflammation,  or  if  the  inflammation 
extends  to  the  parenchyma  it  is  mostly  confined  to  the  sujierficlal  layer 
of  cortical  substance.  Hence  meningitis,  besides  headache  and  intense 
fever,  we  have  an  increase  of  the  general  sensibility,  preternatural  acute- 
ness  of  the  external  senses,  violent  delirium  and  convulsions,  and,  finally, 
collapse,  coma  and  death.  Extensive  and  acute  inflammation  of  the 
hemispheres  of  the  brain  will  be  characterized  by  a  nearly  similar  train 
of  symptoms. 

Two  Classes  of  Inflammation — We  shall  proceed  to  consider  inflam- 
mation of  the  encephalon  under  two  divisions,  viz. :  1.  Inflammation  of 
th.e  membranes  of  the  brain  (meningitis)  ;  2.  Inflammation  of  the  sub- 
stance of  the  brain  fcercbritis). 

Inflammation  of  Brain  Membrane — An  examination  of  the  structure 
of  the  brain  and  of  the  peculiarities  of  the  circulation  in  it  and  ui)on  it 
woiild  lead  us  to  the  inference  that  if  the  meninges  be  the  seat  of  inflam- 
mation, the  contiguous  cerebral  substance  must  participate  in  some  degree 
in  the  irritative  influence.  In  other  organs  the  vessels,  after  entering 
them  by  trunks  and  branches  of  various  sizes,  branch  out  and  ramify  in 
their  interior  until  they  become  capillary  in  their  spongy  and  areolar 
tissue.  ■  But  in  the  brain  a  different  arrangement  takes  place,  the  vessels, 
after  entering  at  the  base  of  the   skull,   communicate  freely  with  one 


410  NEEVOUS  DISEASES. 

another  and  then  branch  out  upon  the  surface  of  the  brain,  ramifying  in 
an  extended  web  of  cellular  tissue  (jiia  mater) ;  in  this  way  they  become 
reduced  to  so  great  a  degree  of  tenuity  before  they  enter  the  substance 
of  the  organ  that  it  may  be  said  to  be  surrounded  by  a  vascular  atmosphere 
from  which  its  supplies  are  derived.  Hence  it  is,  that  as  the  meninges 
and  the  contigiioiis  cerebral  substance  are  supplied  from  the  same  source, 
each  will  more  or  less  become  affected  by  any  inflammatory  action  set 
up  in  the  other. 

Sympathetic  Symptoms — Cerebral  irritations  are  divisible  into  two 
gi-eat  classes,  symptomatic  and  idiopathic.  Symptomatic  irritation  is  for 
the  most  part  connected  with  and  dependent  as  a  morbid  condition  of  the 
chylopoctic  A'iscera.  We  frequently  observe  that  for  weeks  previous  to 
the  occurrence  of  pain  or  any  disturbance  in  the  head  the  digestive  func- 
tions have  been  impaired,  the  bowels  confined  or  irregular  and  the  stools 
nnnatural.  In  many  of  these  cases,  when  the  headache,  retching,  irreg- 
ular fever  and  even  coma  have  set  in,  speedy  and  permanent  relief  has 
followed  the  use  of  purgatives,  and  the  other  means  usually  resorted  to 
for  correcting  disordered  functions.  An  irritative  influence  is  in  such 
cases  propagated  from  the  digestive  organs  to  the  brain  by  reason  of  the 
close  sympathetic  connection  which  subsists  between  them  in  health  and 
in  disease,  and  that  irritation,  if  kept  up  for  a  while,  will  pass  into  positive 
inflammation,  marked  by  its  usual  consequences.  The  irritation  of  worms 
and  of  teething  may  also  induce  similar  results,  more  particularly  in  those 
constitutionally  predisposed.  We  frequently  observe  these  cerebral  affec- 
tions to  spring  up  during  the  course  of  other  diseases,  of  which  they  may 
be  considered  as  complications,  viz. :  continued  fever,  scarlatina,  measles, 
whooping-cough,  and  they  not  infrequently  follow  accidents  or  injuries. 

Varying^  Symptoms — This  affection  presents  a  train  of  symptoms 
which  varies  in  dift'orent  ages  and  in  different  temperaments.  Its  most 
marked  and  ordinary  character  at  its  outset  is  an  increased  sensibility  to 
all  sorts  of  impressions,  the  ordinary  external  influences  producing  inor- 
dinate effects.  Thus,  a  child  is  restless  and  sleepless,  seldom  even  dozing, 
or  if  he  does  doze  from  time  to  time  starting  and  waking  up ;  he  attends  to 
every  sound,  the  eyes  are  suffused,  the  retina  is  so  sensitive  to  liglit  that 
he  wiidis  or  turns  away  if  his  face  is  directed  to  a  window  or  to  a  light; 
the  pupil  is  generally  contracted  but  not  invariably  so.  The  head  is  often 
moved  about  or  from  side  to  side,  so  are  the  limbs ;  the  temper  is  peevish 
and  nothing  seems  to  soothe  this  irritable  condition  but  motion  up  and 
down  the  room  in  the  arms  of  the  nurse  or  attendant. 


BEAIN  FEVEE.  »  411 

Bowel  Symptoms. — The  state  of  the  bowels  varies  much  in  different 
instances,  they  may  be  confined  or  relaxed,  but  the  stools  do  not  present 
any  umiatural  appearance. 

Increased  Animation. — There  is  a  minor  degree  of  this  state  which  is 
marked  by  increased  animation  and  liveliness,  which  with  ordinary  ob- 
servers may  pass  for  an  increase  of  health  and  vigor,  though  an  atten- 
tive observer  will  readily  perceive  that  the  countenance  wants  that  dis- 
engaged air  which  exists  in  health,  and  on  making  a  closer  examination  he 
will  find  that  the  eyes  frequently  close  and  wink  and  the  countenance 
assumes  an  expression  as  of  frowning;  the  hand,  too,  is  frequently  raised 
toward  the  head,  and  the  fingers  are  fixedly  closed. 

Indifference. — We  occasionally  observe  a  state  the  very  opposite  of 
this,  a  state  characterized  by  want  of  animation,  accompanied  by  plaint- 
ive moaning  at  times,  and  an  indifference  to  surrounding  objects.  Though 
the  patient  does  not  sleep,  yet  his  state  is  not  that  of  waking,  and  if  roused, 
betrays  fretfulness  and  ^peevishness.  These  may  be  considered  as  so  many 
indications  of  an  incifdent  irritation,  which  in  some  constitutions  may 
arise  independently  of  any  assignable  agency,  but  which  in  many  cases 
is  referrable  to  an  irritation  propagated  to  the  brain  from  the  peripheral 
extremities  of  the  nerves  during  dentition,  or  by  worms  in  the  alimentary 
canal,  or  by  vitiated  secretions,  or  a  torj^id  liver. 

Fever  Symptoms. — The  symptoms  above  indicated  are  by  some  denomi- 
nated fever,  some  epithet  being  iisually  added  for  the  purpose  of  indicat- 
ing its  source,  or  its  nature ;  hence  the  terms  gastric,  irritative  and  hydro- 
cephalic fever. 

Morbid  Excitement — The  most  expressive  term  which  we  can  employ 
is  that  of  "sensitive  erethism,"  or  morbid  excitement.  It  is  distinct  from 
inflammation  of  the  brain,  of  which  it  is  frequently  the  precursor,  and 
according  to  individual  peculiarities,  or  other  modifying  circumstances,  it 
may  end  in  cerebritis,  meningitis  or  that  modification  of  the  latter  called 
hydrocephalus,  and  this  termination  is  but  too  often  unexpected  by  the 
practitioner,  whose  attention  has  perhaps  been  directed  to  secondary  indi- 
cations and  minor  effects,  while  the  ercthismal  state  of  the  brain  has  crept 
on  imheeded.  The  condition  here  indicated  cannot  be  supposed  to  exist 
unaccoiupanied  by  an  increased  flow  of  blood  through  the  cerebral  vessels, 
or  in  other  words,  an  increase  in  their  degree  of  tension ;  and  as  the  tension 
may  vary  from  a  slight  degree  of  fullness  to  the  greatest  of  which  the 
vessels  are  susceptible,  such  a  state  of  local  determination  of  blood  will 
soon  end  in  inflammation  if  not  subdued  by  proper  means. 


412  •  NEKVOrS  DISEASES. 

Further  Symptoms — Tlie  actual  inflammatory  attack  is  generally 
ushered  in  by  headache  more  or  less  violent  (the  pain  being  referred  to 
the  temples,  the  vortex  or  forehead,  sometimes  to  the  occiput  and  base  of 
the  skull),  by  intolerance  of  light,  heavy  and  suffused  eye,  with  quick 
pulse,  are  also  attendants;  so,  in  many  instances,  is  vomiting.  In  those 
who  have  suffered  much  from  mental  disquiet  spasmodic  twitchings  are 
sometimes  perceived,  not  unlike  those  which  arise  from  slight  electric 
sparks.  In  children  and  very  young  persons  it  frequently  commences  with 
a  sudden  and  long-continued  convvilsiou  without  any  previous  warning. 
After  a  while  the  convulsive  movements  cease,  a  remission  takes  place, 
and  the  patient  appears  fi'ee  from  complaint  for  one  or  more  days,  when 
a  second  attack  occurs  which  may  terminate  in  coma  or  deatli. 

Changes  in  Membrane. — Aftei  having  been  the  subject  of  inflamma 
tion  the  membranes  present  varioiis  changes  dependent  either  on  the  dura- 
tion and  intensity  of  the  attack  or  T)n  the  frequency  of  its  recurrence ;  but 
all  of  them  are  referrable  to  the  following  heads,  viz. :  simple  redness  of 
the  arachnoid ;  thickening  and  opacity  with  increased  firmness ;  serous  ef- 
fusion beneath  or  iipon  it  or  into  the  ventricles;  puriform  or  sero- 
purulent  exudations ;  false  membranes ;  increased  vascularity  and  thicken- 
ing of  the  pia  mater.  We  also  find  lesions  consisting  of  granulations 
scattered  in  the  meninges 'over  the  surface  of  the  brain  and  in  the  sylvan 
fissure,  which  have  been  shown  by  the  microscope  to  be  of  a  tubercular 
nature. 

CHRONIC  MENINGITIS. 

The  Delirium. — Meningitis  is  in  many  instances  so  slow  in  its  progress 
as  to  a:ssume  the  chronic  form.  We  have  then  delirium  and  progressive 
paralysis  as  constant  attendants.  The  delirium  is  at  first  partial,  it  is  a 
monomania  with  weakness  of  intellect,  but,  after  a  time  it  passes  on  to 
maniacal  excitement  and  finally  subsides  into  confirmed  idiocy.  The 
paralysis  in  those  cases  does  not  exhibit  a  total  privation  of  sensation  and 
motion  in  any  particular  part  of  the  body;  it  is  at  first  slight,  but  grad- 
ually increases  and  extends  to  the  whole  muscular  system,  rendering  the 
gait  feeble  and  vacillating  and  iiltimately  destroying  the  power  of  motion. 
It  is  remarkable  that  the  diminution  of  sensation  is  not  proportioned  to 
that  of  motion.  Spasmodic  movements  with  contraction  and  rigidity  of 
the  limbs  sooner  or  later  set  in,  and,  finally,  epileptic  attacks,  which  ter- 
minate in  fatal  apoplexy. 

The  Paralysis — The  paralysis  which  occurs  presents  this  remarkable 


HiTFLAMMATION  OF  BRAIN  StJBSTAKOB.  ^13 

feature,  that  it  seems  to  shift  about  from  one  hour  to  the  other,  one  day, 
for  instance,  the  right  leg  is  found  to  be  drawn  up  with  greater  energy 
than  the  left,  when  the  sole  of  the  right  foot  is  tickled,  but  on  repeating 
the  examination  a  few  days  afterward  it  is  the  left  leg  which  now  feels  and 
moves  better  than  the  right.  It  would  seem  from  this  as  if  the  paralysis 
has  shifted  from  one  side  to  the  other,  but  such  is  not  the  case,  the  limb 
which  was  first  palsied  is  still  so,  but  the  illusion  arises  from  the  circum- 
stance that  the  palsy  has  not  increased  in  degree  in  the  first  limb,  while 
the  second  limb  has  become  involved  to  a  great  degree.  Motor  power  has 
not  returned  in  the  former,  but  has  been  more  gravely  impaired  in  the 
latter. 

After-Death  Facts. — The  lesions  which  are  found  after  death  subse- 
quently accoimt  for  these  facts.  When  the  right  limbs  alone  were  para- 
lyzed the  brain  is  found  to  be  disorganized  on  the  left  side ;  but  when  the 
paralysis  apparently  shifted  from  one  side  to  the  other  both  hemispheres 
are  found  diseased,  but  more  deeply  and  more  extensively  on  the  opposite 
side  to  that  of  the  limbs  which  were  most  palsied.  This  apparent  mobility 
of  paralytic  symptoms  more  frequently  occurs  in  meningitis  than  in  any 
other  complaint. 

Causes. — Meningitis  is  a  frequent  consequence  of  injuries  of  the  head, 
of  fractures,  concussion  or  even  wounds  of  the  scalj).  It  not  infrequently 
happens  that  a  woimd  of  the  head  heals  rapidly  and  that  the  patient 
returns  to  his  usual  occupation  thinking  himself  quite  well,  but  after  ten 
or  fourteen  days  he  begins  to  feel  pain  in  the  situation  of  the  wound  which 
gradually  increases  in  intensity,  and  in  a  very  short  time  all  the  symptoms 
of  cerebral  inflammation  become  manifest.  A  child  may  suffer  serious 
injury  from  a  fall,  and  as  all  mention  of  the  accident  is  suppressed  by  his 
immediate  attendant,  it  escapes  the  notice  of  others  and  no  ill  effects  fol- 
low perhaps  for  a  week  or  two;  the  child  then,  however,  loses  appetite, 
becomes  restless  and  irritable,  febrile  excitement,  delirium  and  convul- 
sions succeed  and  too  often  are  the  precursors  of  a  fatal  termination. 

I^TLAMMATION  OF  BRAIN  SUBSTANCE    (Cerebritis) . 

Symptoms. — The  most  usual  premonitory  symptoms  are  a  general 
uneasiness  and  restlessness  with  a  tendency  to  congestion  in  the  head;  a 
sense  of  weight  and  fullness ;  occasional  attacks  of  pain  in  the  head,  or  of 
temporary  apoplexy  or  epilepsy;  flushing  of  tlie  face  and  increased  heat 
of  the  head;  drowsiness  and  vertigo;  preternatural  acuteness  of  the  ex- 


iSH:  NEEVOUS  DISEASES. 

ternal  senses;  intolerance  of  light  and  optical  illnsions;  contraction  of 
the  pui^ils.  strabismus  or  imperfection  of  sight ;  tinnitus  aurium  or  various 
other  noises  in  the  ear;  confusion  of  thought;  failure  of  the  memory; 
mental  excitement  or  depression,  or  some  striking  alteration  in  the  habitual 
character  and  pursuits  of  the  individual. 

Additional  Symptoms — In  some  cases  there  is  little  appearance  of 
indisposition  throughout  the  day,  but  the  symptoms  are  aggravated  at 
night;  the  sleep  is  uneasy  or  disturbed  by  alarming  dreams,  and  in  chil- 
dren there  is  often  grinding  of  the  teeth.  Pains  in  the  limbs  and  fre- 
quent cramps,  general  lassitude  and  muscular  debility  are  often  felt,  al- 
ternating vith  fits  of  shivering  and  fcvcrishness ;  the  digestive  functions 
are  disordered ;  there  is  a  general  loss  of  appetite ;  often  obstinate  vomit- 
ing; the  bowels  are  either  irritable  or  torpid,  the  secretions  being  always 
unhealthy. 

Symptoms  Following^  Inflammation. — The  above  symptoms  precede 
either  general  or  partial  inflammation  of  the  brain.  Those  which  follow 
indicate  more  esjiecially  the  invasion  of  partial  and  chronic  inflammation, 
a  long-continued,  fixed  and  deep-seated  pain  in  one  part  of  the  head ;  jiain, 
numbness,  weakness,  a  sensation  of  creeping  and  tingling  in  one  extremity 
or  in  one-half  of  the  body,  or  confined  to  one  portion  of  the  extremity; 
there  may  be  niimbnesS  and  loss  of  power  in  one  finger  only  or  in  one  set 
of  muscles.  Sometimes  the  speech  is  affected  so  as  to  produce  a  degree  of 
hesitation,  stuttering  or  indistinctness  of  pronunciation,  drowsiness, 
languor,  depression  of  spirits  are  observed,  also  more  particularly  in  the 
chronic  form  of  cerebritis.  Some  of  these  premonitory  symptoms  may 
have  been  present  for  weeks,  for  months,  or  even  for  a  year,  or  for  a 
longer  period. 

General  Cerebritis — General  cerebritis  is  always  acute.  Its  symptoms 
are  divisible  into  two  periods,  viz. :  1.  The  period  of  irritation  or  excite- 
ment.    2.   The  period  of  collapse. 

Symptoms — The  sjTnptoms  which  characterize  the  period  of  excite- 
ment are  intense  pain  extending  over  the  greater  part  of  the  head;  great 
excitement  of  the  cerebral  functions;  violent  delirium;  preternatural 
acuteness,  of  both  the  external  and  internal  senses;  intolerance  of  light; 
brightness,  redness,  wildness  or  jirotrusion  of  the  eyes ;  contraction  of  the 
pupils ;  tinnitus  aurium ;  flushing  of  the  face ;  throbbing  of  the  temporal 
arteries;  paroxysms  of  general  convulsion;  rigidity  of  some  of  the  mus- 
cles on  one  or  both  sides  of  the  body  in  the  interval  of  the  paroxysms. 
There  are  also  severe  shooting  pains  in  the  extremities,  greatly  increased 


INTLAMMATIOTT  OF  BEAIN.  !il5 

by  extending  them;  twitching  of  the  muscles  of  the  face;  rolling  of  the 
eyes;  quick,  suspicious  and  irregular  breathing;  rapid,  full  and  hard 
pulse;  subsultus  tendinum;  red  and  dry  tongue,  cither  tremulous  when 
protruded  or  in  violent  motion,  j)ushing  out  the  cheek  or  forcibly  thrust 
out  of  the  mouth;  great  thirst;  occasionally  severe  vomiting,  especially 
in  children;  scanty  and  high-colored  urine.  The  paroxysms  of  convul- 
sion are  always  attended  with  an  exacerbation  of  the  symptoms.  The 
respiration  is  hurried,  and  the  pulse  rises  suddenly,  forty  or  fifty  beats 
in  a  minute.  When  the  convulsions  subside  the  pulse  and  respiration  be- 
come comjiaratively  slow  and  feeble. 

Further  Symptoms. — The  S3^uptoms  just  enumerated  may  last  from 
twelve  to  forty-eight  hours  or  more,  when  they  are  succeeded  by  others  of 
an  opposite  character,  which  constitute  the  second  period  or  that  of  col- 
lapse. The  headache  is  now  no  longer  complained  of ;  delirium  gradually 
passes  into  stupor  or  coma ;  the  preternatural  acuteness  of  the  senses  is 
succeeded  by  obtuseness  and  insensibility;  the  convulsions  subside  into 
general  muscular  relaxation  and  more  or  less  comijlete  paralysis  succeeds. 
The  pupils  become  dilated  and  motionless;  the  eyes  sunk,  pale  and  dim; 
there  is  sometimes  strabismiis  or  deafness;  the  pulse  is  rapid,  small,  un- 
equal or  intermittent;  there  are  frequent  rigors,  the  skin  afterward  feel- 
ing cold  and  covered  with  a  clammy  sweat;  the  face  is  pale,  sunk  and 
cadaverous ;  the  respiration  is  slow  or  irregular  and  stertorous.  When  the 
patient  lies  senseless  on  his  back  and  swallows  with  difficulty,  the  fatal 
issue  is  not  far  distant.  There  may  be  several  alternate  paroxysms  o£ 
excitement  and  collapse  until  the  patient  finally  sinks  into  a  state  of  coma 
which  soon  ends  in  death. 

Diagnosis — When  the  inflammation  occupies  at  the  onset  a  large 
portion  of  the  brain,  it  is  generally  complicated  with  meningitis  and 
characterized  by  disturbance  in  all  the  vital  functions. 

Course  of  the  Disease. — When,  however,  a  smaller  portion  of  the  brain 
is  engaged  in  inflammation  the  course  of  the  disease  is  seldom  so  rapid; 
its  invasion  is  more  gradual  and  preceded  by  symptoms  of  irritation  in 
some  of  the  organs  of  voluntary  motion,  sensation  or  intelligence.  Con- 
vulsive rigidity  and  retraction  of  the  muscles  are  sometimes  observed  in 
connection  with  meningitis;  but  it  may  be  generally  distinguished  from 
spasmc^io  paralysis  by  several  well-marked  signs.  There  is  no  actual 
paralysis,  and  when  the  convulsive  retraction  intermits  the  patient  fully 
recovers  the  power  of  voluntary  motion  in  the  same  manner  as  after  the 
paroxysms  of  spasmodic  rigidity  in  tetanus.     This  convulsive  rigidity  is 


416  MEKVOUS  DISEASES. 

scarcely  ever  limited  to  one  region  or  to  one  side  of  tlie  body  as  in  partial 
cercbritis,  but  affects  a  variety  of  parts  at  the  same  time  on  both  sides. 

Treatment The  inilammatory  nature  of  the  more   acute  forms  of 

cerebritis  and  arachnitis  is  so  obvioiis  that  their  treatment  has  always  been 
conducted  in  correct  principles.  Until  very  lately,  however,  the  inflam- 
matory character  of  partial  and  chronic  cerebritis  was  either  entirely  over- 
looked or  imperfectly  understood,  that  though  active  treatment  was  some- 
times adopted  at  the  beginning  of  the  disease  it  was  soon  laid  aside,  and 
remedies  of  an  opposite  description  substituted.  These  affections  were  in 
fact  generally  set  down  as  nervous,  mistaken  for  rheumatism,  neuralgia, 
nervous  dyspepsia  and  debility  or  nervous  palsy,  and  treated  by  tonics, 
electricity  and  stimulants ;  the  fatal  termination  of  the  disease  being  thus 
accelerated. 

Preventive  Treatment. — Cerebritis  and  arachnitis  are  so  formidable 
that  their  prevention  is  of  no  less,  if  not  greater  importance,  than  their 
treatment.  It  is  extremely  imjiortant  to  have  recourse  to  active  measures 
on  the  very  first  appearance  of  any  of  the  premonitory  symptoms,  how- 
ever trifling ;  as  we  may  thus  succeed  in  effectually  removing  that  state  of 
congestion  and  irritation  of  the  brain,  which  is  the  precursor  of  inflam- 
mation. The  means  of  accomplishing  this  are  the  careful  and  timely  re- 
moval of  all  the  exciting  causes ;  of  every  source  of  irritation,  both  bodily 
and  mental ;  regulation  of  the  diet ;  avoiding  all  excesses ;  relaxation  from 
study;  change  of  air;  general  and  local  blood  letting,  counter-irritation, 
with  occasional  purgatives. 

Vigilance  Required — Great  vigilance  is  particularly  required  in  the 
cerebral  affections  of  infants  and  children  who  frequently  suffer  without 
complaining.  A  predisposition  to  affection  of  the  brain  may  often  be 
suspected  by  some  slight  cast  or  rolling  of  the  eyes;  by  dilatation  of  the 
pupils,  or  occasional  startings  or  attacks  of  spasmodic  croupy  breathing 
during  sleep ;  there  may  be  every  other  appearance  of  perfect  health  with 
these  symptoms,  which  are  often  only  evanescent. 

Relieving  Congestion — "When  it  is  necessary  to  relieve  the  brain  from 
habitual  congestion  by  occasional  topical  bleeding,  the  method  of  taking 
blood  from  parts  as  remote  from  the  disease  as  possible  seems  to  us  pref- 
erable to  that  of  abstracting  blood  from  the  head  itself.  Wlien  the  ves- 
sels of  a  part  are  partially  emptied  of  their  blood,  if  they  have  been  much 
weakened  by  long-continued  over-distension  or  previous  disease,  so  as  to 
have  lost  their  elasticity,  there  will  be  an  immediate  flow  of  fresh  blood 
to  the  part ;  this  will  take  place  on  mere  hydrostatic  principles. 


INFLAMMATION  OF  BEAIN.  417 

Uses  of  Bleeding. — No  fact  is  better  establiilied  than  that  the  loss  of 
an  exceedingly  small  quantity  of  blood  from  certain  parts  of  the  body  is 
sufficient  to  relieve  distressing  symptoms  of  congestion  and  oppression  in 
others  most  remote  from  them;  as,  for  instance,  a  very  slight  discharge 
of  blood  (one  or  two  ounces)  from  the  hemorrhoidal  veins  being  suffi- 
cient instantly  to  remove  vertigo,  flushing,  earache  or  oppressed  breath- 
ing; the  same  is  the  case  in  a  still  more  striking  manner  with  the  cata- 
menia,  although  some  account  must  be  taken  of  the  influence  of  uterine 
irritation  over  the  system.  We  prefer,  therefore,  in  cases  of  habitual  con- 
gestion in  the  brain,  taking  blood  occasionally  from  the  feet  or  legs,  by 
opening  a  vein  or  applying  leeches  and  letting  them  bleed  in  a  foot-bath; 
or  the  application  of  leeches  to  the  arms  whenever  practicable.  We  have 
found  this  the  surest  method  of  affording  permanent  relief,  and  by  re- 
peating it  at  certain  intervals  the  tendency  to  cerebral  congestion  may  be 
completely  overcome.  We  have  pursued  this  plan  in  lunatics  with  the 
very  best  results. 

Cooling  the  Head. — The  insertion  of  an  Issue  Is  often  advisable  as  a 
preventive  in  people  of  a  plethoric  habit.  The  head  should  be  kept  cool 
by  the  frequent  use  of  cold  ablutions,  the  hair  cut  short,  the  head  and 
shoulders  raised  at  night ;  tight  bandages  round  the  neck  must  be  avoided ; 
the  daily  use  of  the  cold  shower  bath  Is  often  very  beneficial,  but  a  reac- 
tion takes  place  In  the  head  unless  it  be  used  with  the  feet  Immersed  in  hot 
water.  The  feet,  legs  and  lower  parts  of  the  body  ought  to  be  carefully 
kept  warm  and  dry. 

Further  Treatment — In  the  treatment  of  cerebritls,  when  fully  de- 
velojied,  attention  must  be  paid  to  its  two  periods  of  excitement  and  col- 
lapse. The  remedies  chiefly  to  bo  relied  upon  arc  blood  letting,  general 
and  topical  pvirgatives,  cold  applications  to  the  head  and  counter-irritation. 

Treatment  of  More  Acute  Cases. — In  the  more  acute  cases  the  patient 
must  be  freely  bled  from  a  large  orifice.  If  the  symptoms  continue  iin- 
abated  the  bleeding  must,  however,  bo  repeated  several  times,  at  intervals 
of  a  few  hours,  and  this  practice  must  be  carried  during  the  first  period -of 
the  disease  to  the  utmost  limit  of  the  patient's  strength.  It  often  happens 
that  very  little  impression  Is  made  on  the  disease  by  the  first  bleeding  and 
no  amendment  takes  place  until  after  the  second.  The  symptoms  often 
abate  after  bleeding,  but  a  fresh  exacerbation  may  take  place  in  the  course 
of  a  few  hours.  Topical  bleeding,  by  cupping  or  leeches,  Is,  under  such 
circumstances,  highly  beneficial. 

Head  Treatment.— The  head  must  be  shaved,  and  pounded  ice  mixed 
27 


418  NEEVOUS  DISEASES. 

with  cold  water  and  vinegar  may  be  applied  to  the  scalp.  A  very  effectual 
method  of  applying  cold  is  by  making  the  patient  hold  his  head  over  a 
basin  and  pouring  a  stream  of  cold  water  on  it  from  a  certain  height ;  this 
often  removes  the  heat  and  flushing  and  calms  the  excitement;  it  should 
be  repeated  as  often  as  the  heat  and  flushing  return.  The  application  of 
cold  to  the  body  is  always  followed  by  a  reaction,  and  the  temporary  relief 
refrigerants  afford  will  be  succeeded  by  an  increase  of  the  inflammatory 
symjjtoms  and  their  use  become  decidedly  injurious  imless  their  depress- 
ing action  be  kept  np  by  a  steady  and  repeated  application. 

Other  Remedies. — The  remedies  next  to  bleeding  and  cold,  and  often 
not  less  efficacious,  are  active  purgatives,  which  must  be  administered  at 
short  intervals  until  copious  evacuations  be  procured.  In  some  cases  no 
marked  amendment  has  taken  place  until  the  bowels  have  been  freely 
moved ;  they  are  sometimes  exceedingly  torpid,  for  reasons  which  have 
already  been  assigned,  and  large  doses  of  cathartics  may  be  required.  Com- 
binations of  calomel,  jalap,  scammony,  followed  by  any  of  the  purga- 
tive mineral  waters,  are  the  purgatives  on  which  the  most  reliance  can  be 
placed.  Croton  oil  is  sometimes  a  valuable  remedy,  from  the  facility  of  its 
administration  and  certainty  of  its  effects.  Mercury  may  be  given  freely 
as  a  purgative. 

Use  of  an  Emetic. — "We  have  sometimes  found  tartar  emetic  of  great 
service  when  there  was  no  irritability  of  stomach  to  prevent  its  being 
tolerated ;  the  power  of  tartar  emetic  in  controlling  the  action  of  the  heart 
and  subsiding  the  inflammatory  diathesis  is  now  fully  established ;  a  solu- 
tion in  the  proportion  of  one  grain  to  the  ounce  and  a  tablespoonful  given 
every  hour  or  two,  suspending  it  should  vomiting  occur,  has  often  been 
attended  with  great  benefit.  The  remedy  is  in  general  well  tolerated, 
owing  to  the  torpor  of  the  stomach ;  violent  vomiting  should,  however,  be 
prevented,  as  it  would  obviously  be  extremely  injurious. 

Treatment  of  Second  Stages. — In  the  second  stage  of  acute  cerebritis, 
that  of  collapse  and  coma,  general  blood  letting  is  to  be  used  most  spar- 
ingly; decided  advantage,  however,  has  resiilted  from  a  moderate  bleed- 
ing even  at  a  late  period.  In  this  stage  topical  bleeding  is  more  generally 
indicated.  There  are  periods  of  exacerbation  in  the  symptoms  which 
should  be  watched  and  overcome  by  these  means,  which  may  be  persevered 
iu  as  long  as  there  is  any  hardness  and  resistance  in  the  pulse.  We  have 
seen  a  patient  instantly  recover  from  a  state  of  profound  coma  by  the 
abstraction  of  a  very  small  quantity  of  blood  with  the  cupping  glass.  In 
this  stage  we  may  have   recourse   to   counter-irritation   with   advantage; 


INFLAMMATION  OF  BEAIN.  419 

blisters  may.be  apj^lied  between  the  shoulders,  to  the  occiput  or  to  the  neclc 
or  legs.  There  is  an  objection  to  their  being  applied  to  the  whole  head, 
that  it  prevents  the  subsequent  application  of  cold.  We  have,  however, 
in  desperate  cases,  seen  a  decided  amendment  follow  the  application  of  a 
large  cap  blister.  Particular  attention  should  be  paid  to  the  abdominal 
region,  and  especially  that  of  the  bladdex-,  which  ought  to  be  examined 
morning  and  evening  in  order  to  detect  retention  of  urine,  and  we  must 
take  care  not  to  be  led  into  error  by  an  incontinence  of  urine  from  the 
over-distension  of  the  bladder;  this  must  be  obviated  by  drawing  off  the 
Tirine  Avith  the  catheter  twice  a  day. 

Treatment  of  Chronic  Forms. — In  the  more  chronic  forms  of  cerebritis, 
unattended  with  fever  or  much  general  excitement,  the  same  activity  of 
treatment  is  of  course  not  admissible.  We  must  still,  however,  pursue  the 
antijjhlogistic  plan,  modifying  it  according  to  the  urgency  of  the  symptoms. 
During  the  period  of  irritation,  with  cephalgia,  vertigo,  or  rigid  sjiasm 
of  the  extremities,  moderate  bleeding,  general  and  topical,  purgatives  aud 
counter-irritation  are  the  only  remedies  from  which  any  advantage  is  to  be 
expected ;  they  must  bo  repeated  at  longer  or  shorter  intervals,  according 
as  the  strength  of  the  patient  and  the  continuance  of  the  symptoms  may 
seem  to  indicate.  A  great  deal  is  to  be  accomjilished  in  all  chronic  inflam- 
mations by  persevering  in  a  moderate  course  of  antiphlogistic  treatment. 
We  must  watch  carefully  any  signs  of  amendment,  remembering  that 
there  is  a  great  tendency  to  collapse,  and  that  the  natural  course  of  the 
complaint  is  characterized  by  irregular  remissions  and  exacerbations. 

When  to  Cease  Active  Treatment — When  the  period  of  irritation  is 
over,  and  is  followed  by  a  remission  of  all  signs  of  excitement,  by  a  com- 
plete paralysis  of  the  muscles,  and  by  other  evident  signs  belonging  to  the 
period  of  softening  and  suppuration,  the  strength  of  the  patient  must  no 
longer  be  reduced  by  active  treatment.  In  all  inflammatory  diseases,  when 
the  stage  of  excitement  and  disorganization  is  over,  a  process  of  repara- 
tion commences,  which  requires  for  its  completion  a  certain  degree  of 
power  in  the  constitution.  If  at  this  period  we  persevere  in  lowering  the 
general  strength,  we  de2:)rive  the  constitution  of  its  natural  resources  and 
interfere  with  its  healing  operations. 

When  the  Excitement  Turns. — It  becomes,  therefore,  an  object  of  con- 
siderable importance  to  watch  the  moment  when  the  tide  of  excitement 
is  on  the  turn,  and  when  the  powers  of  the  constitution  are  verging  to  a 
state  of  collapse,  in  order  that  we  may  abstain  from  an  injurious  inter- 
ference, husband  the  patient's  sti-ength  and  even  support  it  if  required. 


420  NERVOUS  DISEASES. 

This  precaution  is  particularly  uecessary  in  old  jieople  and.  young  chil- 
dren. 

Convalescence. — After  convalescence  has  been  established  the  patient 
will  still  require  to  be  closely  watched  for  some  time  before  his  recovery 
can  bo  considered  fully  coutirmed ;  he  must  bo  kept  perfectly  quiet,  free 
from  every  species  of  excitement  and  the  regimen  duly  regulated.  When 
the  brain  has  once  suffered  from  inflammation  it  is  slow  in  recovering  its 
tone,  and  the  most  trifling  cause,  such  as  a  slight  mental  exertion  or  emo- 
tion, a  full  meal,  and  so  forth,  has  been  in  many  cases  sufficient  to 
occasion  a  relapse. 

Suppressed  Menstruation — When  cerebritis  has  occurred  after  sup- 
pressed evacuations  or  the  metastasis  of  other  diseases,  we  should  endeavor 
to  procure  their  return.  If  menstruation  is  suppressed,  leeches  should  be 
ajiplied  to  the  pubis  or  inguinal  regions,  and  the  frequent  use  of  hot 
pediluvia  recommended.  If  cutaneous  eruptions  or  rheumatic  gouty  pains 
in  the  joints  previously  existed,  blisters  or  rubefacients  are  to  be  applied 
to  the  parts  originally  affected. 

Summary  of  Symptoms  of  Brain  Congestion The  following  summary 

gives  a  connected  view  of  the  various  morbid  conditions  of  the  brain, 
which  are  the  effects  of  congestion  and  inflammation,  together  with  their 
symptoms : 

Cerebral  Congestion — Cerebral  congestion,  over-distension  of  vessels; 
vertigo,  tinnitus  auriura,  confusion  of  sight,  cei>halgia,  if  the  pressure 
in  the  vessels  be  carried  to  a  sufficient  extent  to  intercept  the  circulation ; 
simple  apoplexy,  seldona  fatal,  recovery  rapid. 

Permanent  Cerebral  Congestion. — If  the  cerebral  congestion  be  per- 
manent, or  returns  frequently ;  drowsiness,  oppressed  intellect ;  the  vessels 
become  weakened  and  on  a  sudden  increase  of  congestion  are  ruptured ; 
extravasation  of  blood,  sanguineous  apoplexy ;  destruction  of  cerebral  sul> 
stance  and  compression;  loss  of  consciousness,  permanent  or  temporary; 
sudden  and  complete  paralysis  without  spasmodic  affection  of  the  muscles. 

General  Congestion. — General  congestion,  followed  by  inflammation 
of  a  considerable  portion  of  the  brain ;  deep  injection ;  partial  sanguineous 
infiltration;  dotted  and  ecchymoscd  striated  appearance  of  the  cerebral 
substance;  general  cerebritis  (combined  usually  with  arachnitis).  Period 
of  high  excitement  of  all  the  cerebral  functions,  with  general  convulsions, 
followed  by  a  period  of  collapse  and  coma. 

Partial  Congestion — Partial  congestion  and  inflammation  of  the 
brain;   1st  period,  the  same  deep  injection  and  sanguineous  infiltration. 


SPINAL  MENINGITIS.  421 

more  circumscribed ;  partial  ccrebritis.  Partial  symptoms  of  irritation  in 
the  organs  of  motion  and  sense;  weakness,  pain,  numbness,  spasmodic 
paralysis,  confined  to  one  side  or  a  few  regions  of  the  body.  2d  period, 
infiltration  of  piis  in  the  cerebral  substance ;  softening ;  abscess ;  complete 
paralysis;  relaxation  and  flaccidity  of  the  muscles;  loss  of  feeling;  aboli- 
tion of  some  of  the  external  senses  or  intellectual  faculties ;  death,  either 
gradual  or  sudden,  by  the  extension  of  the  inflammation  or  by  pressure. 

Cerebral  Inflammation. — After  sanguineous  apoplexy  and  sudden  and 
complete  paralysis,  inflammation  of  the  cerebral  substance  surrounding 
the  coagulum;  consecutive  ccrebritis,  the  paralyzed  limbs  affected  with 
pains,  convulsive  motion,  spasmodic  rigidity. 

Slow  Congestion — Slow  and  gradual  congestion  with  very  slight  irri- 
tation; long,  continued  state  of  low  inflammation,  ending  sometimes  in 
softening,  sometimes  in  induration,  or  else  in  an  infiltration  of  serous 
fluids  and  white  softening.  Various  forms  of  chronic  ccrebritis,  sense 
and  motion  very  gi-adually  weakened  and  impaired  without  pains  or 
spasmodic  rigidity  in  the  muscles. 

DROPSY  OF  BRAIN. 

(Hydrocephalus. ) 

Causes — "Water  in  the  head;  dropsy  of  the  brain.  This  is  almost 
always  an  affection  of  early  life.  Sometimes  it  is  congenital.  It  is  mostly 
a  passive  dropsical  eft'usion ;  certain  cases  show  signs  of  a  chronic  or 
subacute  inflammatory  condition  of  the  arachnoid  membrane  of  the  brain. 

Symptoms. — Languor,  strabismus,  convulsions,  loss  of  appetite  and 
increase  in  the  size  of  the  head.     This  last  may  be  enormous. 

Treatment — Moderate  purging  every  few  days,  or  once  a  week,  sus- 
taining the  strength  by  nourishing  food,  and,  if  it  be  borne,  cod-liver  oil; 
diuretics;  shaving  the  head  and  rubbing  it  nightly  with  mercurial  oint- 
ment ;  occasionally  blistering  the  back  of  the  neck,  in  a  child.  Pneumatic 
aspiration  may  perhaps  prove  useful  in  hydrocephalus.  To  remove  the 
fluid  gradually  and  safely  mild  stimulating  baths  have  a  very  beneficial 
influence. 

INFLAMMATION  OF  THE  SPINAL  MARROW,  MYELITIS,  SPINAL 

MENINGITIS. 

Symptoms. — The  symptoms  of  this  uncommon  affection  arc :  constant 
and  severe  pain  in  tlie  back  increased  by  motion ;  spasmodic  contractions 


422  ITEEVOTJS  DISEASES. 

or  rigidity  of  the  muscles  followed  by  paralysis,  fever,  constipation  of  the 
bowels  and  retention  of  urine.  In  myelitis  proper,  as  distinguished  from 
spinal  arachnitis,  there  is  no  pain  or  muscular  rigidity  hut  only  paralysis 
of  motion  and  sensation. 

Treatment. — Cupping  or  leeching  along  the  spine,  followed  by  a 
blister  and  active  purgation  with  saline  cathartics,  constitiite  the  essential 
parts  of  the  treatment  of  simple  inflammation  of  the  spinal  cord  or  of  its 
membranes. 

APOPLEXY. 

Causes. — These  have  been  divided  into  external  or  obvious,  and  in- 
ternal or  such  as  can  only  be  discovered  after  death.  The  external  causes 
or  those  acting  mechanically  by  evoking  pressure  on  the  brain;  snch  are 
fracture  of  the  skull  with  depression  of  a  portion  of  bone,  or  blood  extrava- 
sated  immediately  beneath  tlie  fractured  bone  without  depression.  The 
reality  of  this  cause  is  shown  by  the  effect  of  direct  pressure  made  upon 
the  surface  of  the  brain  by  the  point  of  the  finger  in  cases  where  a  portion 
iof  the  skull  has  been  removed  by  the  trepan,  or  on  the  fontanelle  on 
opening  between  the  cranial  bones  in  the  head  of  infants.  Causes  tend- 
ing to  increase  the  arterial  action  of  the  brain,  either  by  direct  application 
to  the  head  itself,  or  indirectly  through  the  medium  of  other  organs. 
Causes  which  operate  by  impeding  the  return  of  blood  from  the  brain, 
as  stooping;  the  application  of  a  tight  ligature  round  the  neck  so  as  to 
compress  the  internal  jugular  veins;  tumors  of  any  kind  so  situated  in  the 
Deck  or  chest  as  to  interrupt  the  return  of  blood  from  the  brain  to  the 
heart;  diseases  of  the  heart  or  lungs  impeding  the  transmission  of  the 
blood  through  the  pulmonary  vessels ;  or  a  voluntary  suspension  of  breath- 
ing after  a  full  inspiration ;  or  in  blowing  wind  instruments,  or  in  making 
great  muscular  efforts  of  any  kind.  The  internal  causes  ai-e  those  that 
are  only  discoverable  after  death,  viz. :  extravasation  of  blood  in  the 
substance  of  the  braifi.  or  in  the  ventricles,  or  serous  accumulations  iu 
any  of  tlie  cavities  or  between  its  membranes. 

Symptoms — We  have  two  forms  of  geni:ine  apoplectic  seizure :  con- 
gestive and  hemorrhagic.  In  the  first  the  premonitory  symptoms  are, 
carotids,  distension  of  the  temporal  arteries  and  jugiilar  veins;  constipa- 
tion, languor,  dullness,  drowsiness,  dimness  of  sight,  vertigo,  headache. 
The  attack  is  marked  by  sudden  stupor ;  with  slow  and  sometimes  snoring 
respiration,  full  and  slow  pulse,  dusky  or  turgid  appearance  of  the  face. 
The  total  loss  of  perception  may  be  brief,  its  partial  absence  or  deficiency 


T,osg  OP  SPEECH.  423 

continuing  for  some  time.  Slight  convulsive  movements  are  not  uncom- 
mon. Paralysis  of  the  muscles  occurs  only  for  a  short  time  after  the 
attack,  if  recovered  from. 

Hemorrhagic  Apoplexy — In  hemorrhagic  apoplexy  generally  no  clear 
premonition  is  given,  the  attack  being  very  sudden;  a  stroke,  literally 
unconsciousness  is  complete  for  some  seconds,  minutes  or  hours.  After 
this,  general  or  local  paralysis,  most  often  hemiplegia  (paralysis  of  one 
side  of  the  body)  is  left;  the  mental  powers  also,  in  many  cases,  being 
impaired  at  least  temporarily,  during  the  coma;  the  breathing  is  com- 
monly stertorous  and  the  pulse  slow  and  somewhat  full,  the  head  hot  and 
the  face  more  or  less  dark  or  flushed.  But  the  fullness  of  the  blood-vessels 
and  heat  of  the  head  are  much  less,  as  a  rule,  than  in  congestive  apoplexy. 

The  younger  the  patient  and  the  more  vigorous  his  antecedent  health 
the  more  probable  is  the  existence  of  the  congestive  form;  and,  also,  the 
better  the  prosf)ect  of  recovery  from  hemorrhage  within  the  cranium, 
if  only  the  effects  of  pressure  be  exerted  at  the  time. 

Treatment — 1.  If,  in  a  person  under  fifty,  not  before  of  broken  con- 
stitution, we  find  the  head  hot,  face  turgid  and  flushed,  the  arteries  and 
veins  of  the  neck  and  temples  full,  the  pulse  also  strong,  and  the  heart's 
impulse  so  (or  the  heart's  action  vigorous  though  the  pulse  at  the  wrist 
be  oppressed)  blood  may  be  taken,  carefully,  from  the  arm  or  by  cups  or 
leeches  applied  to  the  back  of  the  neck. 

2.  Older  and  more  doubtful  cases  may  be  treated  tentatively  with 
cups  alone,  aided  by  mustard  plasters  to  the  legs,  back  and  epigastrum  in 
turn;  with  laxative  injections  into  the  rectum  during  the  attack  and 
saline  purgatives  afterward.  The  head  should  be  kept  raised  and  cooled 
with  wet  cloths  until  its  temperature  becomes  normal.  If  the  hair  be 
thick,  it  should  be  cut  very  short  or  shaved  off  entirely  and  an  ice-cap 
placed  thereon  over  the  whole  surface.  When,  however,  there  is  reason, 
as  usually  is  the  case  in  really  old  or  broken-down  patients,  to  believe  the 
structural  degeneration,  arterial  or  that  of  ramollissement,  is  the  source 
of  the  attack,  loss  of  blood  will  be  out  of  place.  Iodide  of  potassium  for 
some  time  will  aid  absorption. 

loss  OF  SPEECH. 

(Aphasia.) 

Symptoms.- — Loss  of  speech  may  occur  as  one  of  the  symptoms  of 
disease  of  the  brain,  either  functional  and  transient,  or  organic  and  irre- 


424 


NEHVOUS    niSEASES. 


THE  NERVES 


Figure 

No.    I. 

I. 

Plexus   or   bunch   of   nerves    in 

the  carotid  region. 

2. 

Sixth  external   motor  nerve. 

3- 

First  branch  of  the  5th  ophthal- 

mic nerve. 

4- 

A  branch  on  the  nose  partition, 

which     goes    to    the    incisive 

foramen. 

5- 

Concurrent  branch  of  the   I'id- 

ian  nerve,  dividing  itself  into 

cirotid  and  petrosas  branches. 

6. 

Back  branches  of  the  palate. 

7- 

Lingual    nerve    joined    by    the 

tympanum  cord. 

8. 

Hard   part    of   the   7th   pair   or 

facial  nerve. 

9- 

Upper  cervical  ganglions. 

10. 

Middle  cervical  ganglions. 

II. 

Lower   cervical  ganglions. 

12. 

Roots  of  the  great  splenic  nerve. 

13- 

Lesser  splenic  nerve. 

14- 

Renal  plexus. 

IS. 

Solar  plexus. 

i6. 

Mesenteric  plexus. 

17. 

Lumbar  ganglions. 

i8. 

Sacrum  ganglions. 

19- 

Vesical   plexus. 

20. 

Rectum  plexus. 

21. 

Lumbar  plexus. 

22. 

The   rectum. 

23.  The  bladder. 

24.  The  pubis. 

25.  Crest  of  the  ileum. 

26.  The  kidney. 

27.  The  aorta. 

28.  The   diaphragm. 

29.  The  heart. 

30.  The  larynx. 

31.  The  submaxillar  gland. 


32.  The   incisive  teeth. 

33.  The  nasal  partition. 

34.  Globe  of  the  eye. 

35.  36.  Cavity  of  the  cranium. 


Figure  No.  2. 

1.  Section  of  the  bone  of  the  fore- 

head. 

2.  Section  of  the  occipital  bone. 

3.  Muscles  in  the  back  of  the  neck. 

4.  Integuments  on  the  skin. 

5.  Frontal  cavity. 

6.  Middle  spongy  bone. 

7.  Lower  spongy  bone. 

fj.     Middle  passage  of  the  nose. 
9.     Lower  passage  of  the  nose. 

10.  Thickness    of    the    roof   of   the 

mouth  and  depth  of  the  nose. 

11.  Opening  of  the  eustachian  tube. 

The   catheter    is    at   the   nose 
and  is  going  through  the  tube. 

12.  Cartilage  of  the  nasal  division. 

13.  Coiio-iiloso   muscle. 

14.  Veil  of  the  palate. 


Figure  No.  4. 

1.1.  The  cubital  nerve. 

2.2.  The     ramus     profundis     dorsalis 

(deep-seated  nerve  of  back  of 

arm). 
Extreme  of  the  cutaneous  nerve 

of  the  arm. 
Branch  of  the  radial  nerve. 
Back  view  of  the  digital  nerves, 

or  of  the  fingers. 
Back     branch     of     the     cubital 

nerve. 


3- 


4- 

5,5- 


FxQ.  1.— Tiie  great  gympathellc  uerve 


Fig.  3. — View  of  tlie  nervous  system  in  man,  showing  the  nerv- 
ous centres  (the  brain  ami  the  spinal  near  rowj  whence  start  the 
other  nerves  which  piovide  the  whole  body. 


Vm.  4.— Vifw  of  l!ie  nerves  on  the  back  part  of  the  forearm  and  hand. 

THE  NERVES. 

Fur  an  explauatloxi  uf  the  iUiLiLratiouii  sou  text  on  opposite  page. 

425 


426  liTEEVOTTS  DISEASES. 

movable.  Such  a  loss  of  language  is  termed  aphasia,  not  articulation,  as 
in  aphonia,  but  expression  is,  in  this  affection,  wanting.  The  power  to 
unite  words  from  memory,  to  convey  meaning,  is  lost ;  but,  in  some  cases, 
at  least,  they  may  be  copied  correctly. 

Causes. — Hemiplegia  of  the  right  side  has  in  a  number  of  examples 
coincided  with  aphasia,  and,  several  times,  also,  autopsy  has  shown  soften- 
ing or  other  lesion  of  the  left  anterior  portion  of  the  cerebrum.  Valvular 
lesion  of  the  heart  sometimes  accompanies  this  disease. 

Treatment. — Cases  of  aphasia  are  very  rare.  There  is  no  special 
measure  of  treatment  except  that  of  general  principles,  and  treat  untoward 
ones  as  they  arise. 

SUN  STROKE. 

Symptoms. — This  is  a  disease  occurring  in  persons  exposed  to  exces- 
sive heat  and  characterized  by  vertigo,  sometimes  with  violent  pain  in  the 
head,  gradual  increase  of  listlessness  and  torpidity  and  a  desire  to  lie  do-wn. 
The  feverish  sj-mptoms  may  culminate  in  more  or  less  sudden  and  com- 
plete insensibility. 

Treatment. — The  most  obvious  demand  in  regard  to  treatment  is  to 
abstract  the  excessive  heat  from  the  body  as  rapidly  as  possible,  and  this 
can  be  most  speedily  accomplished  by  cold  sponging,  rubbing  the  head, 
neck  and  chest  with  ice  or  by  the  cold  pack.  Light  should  be  excluded  from 
the  patient  as  far  as  possible,  and  if  the  pulse  is  feeble  stimulants  should 
be  given  by  the  moiith  or  by  injection.  If  prompt  improvement  does  not 
occur  the  hair  should  be  cut  short  and  a  blister  api^lied  to  the  nape  of 
the  neck. 

Heat  Exhaustion — In  heat  exhaustion  the  patient  is  generally  found 
with  a  cool  skin,  a  feeble  pulse  and  pallid  face,  without  disturbance  of  the 
intellect.  In  such  a  condition  stimulants,  dry  heat  of  hot-water  bags  or 
bottles,  mustard  plasters  to  the  stomach  and  perfect  rest  and  quiet  are 
indicated. 

HYPERTROPHY  AND  ATROPHY  OF  THE  BRAIN. 

Meaning. — Hypertrophy  means  an  actual  enlargement  or  overgrowth 
of  the  brain  structure  generally,  while  atrophy  signifies  a  general  wasting 
of  the  substance  of  the  brain 

Causes — The  brain  is  sometimes  the  seat  of  morbid  growths,  includ- 
ing cancers,  fibroid  and  bony  tumors,  tubercular  deposit  in  large  masses, 


PAEALYSIS   OE   PALSY.  427 

and  casts  containing  parasites.    All  these  affections  are,  fortunately,  very 
seldom  met  with. 

Treatment. — The  treatment  in  such  cases  is,  of  course,  to  cut  out  the 
tumor  and  the  affected  portion  of  the  nerve  with  as  little  delay  as  possi- 
ble, whenever  it  can  he  accomplished. 

PARALYSIS  OE  PALSY. 

Causes. — Palsy  is  one  of  the  most  common  and  most  distressing  mis- 
fortunes which  mankind  is  obliged  to  suffer.  Yet  its  various  forms  are 
rather  symptoms  of  deep-seated  disease  than  disease  themselves.  Thus 
palsy  of  a  limb  is  very  frequently  a  symptom  of  structural  disease  of 
the  brain  or  spinal  cord,  but  it  occasionally  occurs  from  a  diseased  nerve 
trunk  itself.  It  may  affect  a  whole  limb  or  only  part  of  one,  and  is 
sometimes  limited  to  a  group  of  muscles  in  a  particular  region. 

Symptoms — The  following  conditions  give  rise  to  paralysis  of  motion: 

1.  Disease  or  injury  to  a  nerve  in  some  part  of  its  course,  destroy- 
ing its  power  of  transmitting  the  force,  which  is  expressed  by  a  contrac- 
tion of  the  muscle  to  which  the  nerve  is  distributed. 

2.  A  disease  of  some  portion  of  those  central  parts  of  the  nervous 
system,  whence  the  nerve  takes  its  origin,  or  with  which  it  may  be  con- 
nected directly  or  indirectly. 

Varieties  of  Palsy. — There  are  many  varieties  of  palsy,  among  the 
most  important  of  which  are  the  following: 

According  to  its  nature  it  may  be  motor  (acinesia),  and  sensory 
paralysis  (anesthesia). 

Facial  Palsy — This  is  an  affection  of  the  portio  dura  of  the  seventh 
pair  of  cephalic  nerves,  the  motor  nerve  of  the  face.  It  occurs  at  any  age, 
usually  from  rheumatoid  inflammation  of  the  sheath  of  the  nerve  at  its 
escape  through  the  cranium,  through  the  stylo-mastoid  foramen. 

Symptoms — One  side  of  the  face  is  without  change  of  expression, 
and  the  eye  on  that  side  is  not  closed  (in  severe  cases)  from  the  paralysis 
effecting  the  orbicularis  palpebra  muscle.  The  tongue  is  not  affected  in 
the  movements.  The  facial  motor  nerve  is  not  often  involved  in  the 
much  more  serious  cases  of  cerebral  palsy. 

Diagnosis. — Absence  of  disturbance  or  of  incompleteness  of  control 
over  the  tongue,  while  the  power  over  the  eyelid  is  partly  or  wholly  lost 
with  the  absence  of  severe  cerebral  symptoms,  will,  especially  in  a  young 
person,  make  the  diagnosis  easy  as  well  as  important. 


428  JfEEVODS  DISEASES. 

Treatment.- — The  treatment  of  this  form  of  local  palsy  may  be  by 
repeated  small  blisters  behind  the  ear,  followed,  when  convalescence  has 
begun,  by  some  warm  covering  (cotton  wadding,  flannel  or  silk)  to  protect 
the  part  from  cold. 

Writer's  Cramp — Pressure  npon  a  nerve  may  cause  its  paralysis,  gen- 
erally temporary.  A  man  lias  been  known  to  have  his  hand  rendered 
powerless  for  throe  weeks  by  sleeping  all  night  with  his  arm  bent  under 
his  head.  Friction,  the  enderaiic  application  of  strychnia  and  galvanism 
may  be  used  in  such  a  case.  Writer's  cramp  or  scrivener's  palsy,  is  the 
result  of  exhaustion  of  certain  muscles  from  over-use.     Its  cure  is  rest. 

Hemiplegia. — This  means  half  palsy  and  is  a  paralysis  in  which  one 
lateral  half  or  side  of  the  body  is  stricken  with  powerlessness  so  accurately 
that  it  is  customary  to  define  the  condition  by  the  terms  right  and  left. 

Causes — Brain  lesion  is  most  often  the  cause  of  this  affection ;  either 
an  apoplectic  clot,  a  tumor  or  softening. 

Symptoms. — In  severe  cases  the  arm  and  leg  may  be  equally  motion- 
less, but  if  there  is  any  difference  between  them  the  leg  is  generally  the 
limb  less  affected,  the  last  to  be  attacked,  and  the  first  to  recover  some  of 
its  powers.  Suddenly,  almost  always,  but  uot  always  with  loss  of  con- 
sciousness, the  patient  loses  the  power  of  motion  and  more  or  less  sensa- 
tion on  one  side.  In  complete  cases  the  j^arts  involved  are  the  arm  and 
leg,  the  muscles  of  mastication  and  half  the  tongue. 

Treatment. — 1.  Essentially  the  same  principles  are  applicable  to  this 
as  have  been  mentioned  in  connection  with  ajioplexy.  The  younger  the 
patient  the  more  vigorous  bis  or  her  previous  health,  and  the  fuller  the 
circulation  the  more  approi^riate  may  be  the  general  or  local  abstraction 
of  blood  to  diminish  pressure  upon  the  brain.  Where  softening  is  appre- 
hended bleeding  should  be  exceptional  and  cautious.  Eest,  regulation  of 
the  bowels,  and  counter-irritation  of  dry  cups  to  the  iipper  part  of  the 
spine,  and  afterward  a  blister,  with  friction,  as  with  brandy  and  red 
pepper,  or  whiskey  and  hot  water,  or  salt  and  spirits,  to  the  affected  limbs. 

2.  In  the  hysterical  form,  if  it  lasts  long,  electricity  may  be  aj^plied 
locally  with  safety  and  advantage.  In  any  curable  case  passive  exercise 
of  the  weak  limbs  will  be  very  useful. 

Paraplegia — Paraplegia  is  that  form  of  palsy  in  which  one-half  of 
the  body  below  the  chest  and  including  the  lower  limbs  is  stricken  with 
the  disease. 

Causes. — Spinal  disease  or  injury  is  its  source,  with  or  without  core- 


PARALYSIS    OR    PALSY.  429 

bral  implication  or  complication.  It  may  come  suddenly  or  gradually; 
generally  its  beginning,  at  least,  is  sudden. 

Symptoms. — When  the  spine  is  affected,  as  well  as  iu  the  reflex  form, 
numbness  in  the  feet  and  pain  in  the  back  are  apt  to  be  early  signs.  The 
power  of  motion  is  lessened  or  lost  in  the  lower  limbs.  The  muscles  may 
be  either  relaxed  or  contracted.  The  lesion  of  the  spinal  marrow,  if  pro- 
gressive, is  productive  of  loss  of  power  over  the  bladder  and  bowels. 
Bed-sores  with  deep  ulceration  and  sloughing  may  occur  in  protracted 
cases. 

Treatment. — When  myelitis  is  believed  to  exist,  at  an  early  stage, 
local  depletion  to  a  moderate  extent  may  be  advised.  In  many  cases  coun- 
ter-irritation by  repeated  sinapisms,  or  stimulating  liniments  will  be 
proper.  While  inflammation  or  active  irritation  of  the  spinal  cord  is 
made  apparent  by  the  symptoms  (pain,  cramps,  muscular  twitching  or 
rigidity),  strychnia  is  not  suitable.  After  these  have  subsided  it  may  be 
given,  not  more  at  first  than  the  thirtieth  of  a  grain  twice  daily.  If  it 
produce  jerking  movements  of  the  hands  or  feet,  or  nervous  restlessness, 
or  any  marked  imeasiness  it  should  be  suspended.  Electricity  may  be 
used  with  similar  caution  in  a  secondary  stage  of  parajalegia. 

Hysterical  Paralysis. — In  females  this  is  among  the  many  foi'ms  of 
functional  disorder  which  that  strange  but  not  yet  clearly  defined  dis- 
order, hysteria,  may  produce. 

Diagnosis, — The  affected  limb,  in  walking,  is  dragged  after  the  other, 
as  if  a  dead  weight ;  while  in  cerebral  hemiplegia  the  palsied  leg  and  foot 
are  brought  round  in  a  curve,  the  body  being  bent  toward  the  sound  side 
at  the  time. 

Treatment. — Tonics,  good  nourishment  and  change  of  air  are  most 
required  in  all  hysterical  cases.  For  the  paralysis  itself  electricity  is  use- 
ful. Mild  shocks  for  a  few  minutes  twice  a  day  may  be  given  with 
advantage. 

Eeflex  Paralysis — Causes — Worms,  dysentery,  diarrhoea,  uterine  irri- 
tation, teething  and  external  injuries  are  all  thought  to  induce  reflex 
paralysis  in  certain  instances.  Diphtheritic  and  scarlatinal  palsies  have 
been  placed  in  the  same  category.  The  simplest  and  clearest  cases  are 
those  of  wovinds. 

Treatment. — In  true  reflex  paralysis  the  removal  of  the  irritant  cause 
produces  instant  relief.  When  the  nature  of  the  case  does  not  admit  of 
such  prompt  relief,  if  the  diagnosis  be  clear,  the  same  indication  roinni'^r;, 
to   address   our   remedial   measiires   to  the   seat  or  source   of  ]ieriplior:il 


430  NERVOUS  DISEASES. 

irritation.  Palliate,  if  we  cannot  cure  the  trouble  there,  and  we  will  ob- 
tain palliation,  if  not  i-elief,  of  the  reflex  disability.  Electricity  has 
proved  signally  useful  in  the  subsequent  treatment. 

Diphtheritic  Paralysis. — After  the  termination  of  an  attack  of  diph- 
theria, commonly  within  three  weeks,  the  muscles  used  in  swallowing  and 
speaking,  less  often  those  of  the  upper  and  lower  limbs  and  the  sense  of 
sight  may  be  partially  paralyzed.  Loss  of  sensibility  usually  accompanies 
the  loss  of  motor  power.  This  condition  of  things  may  last  for  weeks  or 
even  months,  but  is  generally  recovered  from. 

Causes. — The  inunediate  cause  of  the  paralysis  of  the  peripheral 
lesion  of  the  nervous  terminations  is  the  toxemic  influence  upon  those 
centres  of  the  morbid  poison  of  diphtheria. 

Treatment — Passive  exercise,  stimulating  friction  and  electricity, 
change  of  air  and  sea-bathing  are  suitable  measures  for  this  affection. 

Syphilitic  Paralysis. — The  most  unequivocal  instances  of  this  nature 
are  accounted  for  by  periostitis  within  the  cranium,  involving  the  dura 
mater,  or  by  nodular  exostosis  pressing  upon  the  brain.  The  most  remark- 
able fact  connected  with  such  cases  is  the  prompt  curative  effect  upon  it 
of  iodide  of  potassimn. 

lead  Palsy. — Considerable  time  of  exposiire  to  the  influence  of  lead 
is  generally  necessary  to  cause  this.  So  commonly  does  it  first  affect  the 
extensor  muscles  of  the  forearm  that  the  cognomen  of  "wrist  drop"  is 
often  applied  to  it.  When  it  lasts  for  some"  weeks  the  muscles  waste 
away. 

Symptoms. — A  blue  line  is  observed  to  form  along  the  edge  of  the 
gums.  Pain  precedes  the  palsy  and  attends  recovery  of  power.  Mostly, 
though  after  a  long  time,-  lead  palsy  is  recovered  from. 

Treatment. — Iodide  of  potassium  appears  to  act  as  an  eliminant  of 
the  lead  accumulated  in  the  system.  Ergot  is  also  useful.  Faradic  elec- 
tricity has  been  found  decidedly  beneficial  used  in  moderate  strength  for 
a  few  minutes  two  or  three  times  a  day. 

Mercurial  Palsy — This  is  occasionally  met  with  in  those  who  work 
in  metal.  Mostly  tremor  is  a  predominant  symptom.  Early  withdrawal 
from  the  influence  of  the  caiise  and  the  continued  use  of  the  iodide  of 
potassium  are  the  principal  measures  of  treatment. 

Paralysis  Agltans,  called  also  shaking. palsy,  is  described  as  a  more 
or  less  constant  involuntary  and  uncontrollable  shaking  of  the  hands,  arms, 
head  or,  progressively,  of  the  whole  body.  Slight  or  moderate  degrees  of 
such  tremor  are  common  enough  from  general  nervous  debility.    Extreme 


PABALTSIS   OR   PALST.  431 

cases  evince  the  wreck  of  the  cerebro-spinal  system  and  are,  therefore, 
incurable.     In  other  cases  the  treatment  is  upon  general  principles. 

Progressive  Muscular  Atrophy — This  is  still  another  uncommon  and 
incurable  form  of  paralysis  due  to  a  gradual  decay  and  wasting  of  the 
muscles,  but  commencing  sometimes  with  an  apparent  enlargement  or 
hypertrojjhy  of  these  organs. 

Locomotor  Ataxia — This  results  from  a  disease  called  sclerosis,  or 
hardening  of  certain  motor-centres  in  the  brain  and  spinal  cord,  or 
syphilis. 

Symptoms. — Eheumatoid  pains  precede  loss  of  power,  occasional  stra- 
bismus (cross-eye)  and  incontinence  of  urine  may  occur.  Then  there  is 
an  awkward,  unsteady  gait;  the  sensibility  of  the  feet  becomes  blunted, 
and  walking  is  insecure.  If  the  patient  shuts  his  eyes  he  falls  down,  and 
even  with  them  open  he  reels  as  if  drunk.  The  duration  of  this  progres- 
sive disease  varies  from  six  months  to  ten  or  twenty  years. 

Treatment. — Hygienic  management,  general  tonics,  electricity  and 
very  careful  use  of  strychnia. 

Infantile  Paralysis — This  is  a  variety  developed  in  very  young  chil- 
dren and  occasionally  jjresent  from  time  of  birth.  As  a  rule  this  palsy 
arises  from  disease  of  the  spinal  cord  and  its  membranes. 

Symptoms — It  comes  on  with  acute  symptoms  of  fever  and  con- 
vulsions, ending  in  paralysis  of  one  or  more  limbs.  In  some  cases  the 
child  gradually  recovers  from  the  effects  of  the  malady,  but  in  many  the 
impairment  is  permanent  and  the  limb,  ceasing  to  develop  in  proportion 
to  the  rest  of  the  body,  ajjpears  in  the  adult  as  if  shrunken  and  withered, 
constituting  a  lamentable  and  hopeless  deformity. 

Treatment — Much  can  be  done  towards  preventing  complete  loss  of 
power  by  persevering  and  systematic  movements,  api^lication  of  galvanism 
and  exercise  as  suggested  in  the  article  on  hemiplegia. 

Scrivener's  Palsy. — Called  also  writer's  cramp.  It  is  the  result  of  long 
continued  and  unnatural  excitement  of  the  nerves  coutrolliug  the  fingers 
and  hand  in  writing. 

Symptoms — The  earliest  indication  is  a  painful  sense  of  fatigue  and 
weakness  which  comes  on  shortly  after  commencing  to  write.  Sooner  or 
later  this  begins  to  be  accompanied  by  involuntary  spasms  of  the  muscles 
employed  in  holding  the  pen  and  the  handwriting  grows  unsteady,  scrawly 
and  almost  illegible.  At  first  the  spasms  and  irregular  movements  can 
be  more  or  less  controlled  by  voluntary  effort,  but  they  gradually  become 
worse  and  worse,  until  at  last  the  use  of  the  pen  is  an  impossibility. 


432  NERVOUS  DISEASES. 

Treatment. — IJcst  from  writing,  tonics  and  electricity  accomplish  a 
cure  in  some  instances,  but  the  prospect  of  recovery  is  small,  and  it  is, 
therefore,  very  important  to  avoid  the  disease  by  moderation  in  writing,  or 
by  the  use  of  the  ingenious  typewriter. 

Wasting  Palsy. — A  few  of  the  muscles  of  one  limb,  or  the  voluntary 
muscles  of  the  whole  body  may  lose  their  power  and  then  waste  away 
to  almost  nothing.  Insidious  in  its  approach  the  affection  may  last  from 
six  months  to  several  years.  It  may  end  in  recovery.  The  shoulder  and 
ball  of  the  thumb  are  frequent  points  of  commencement  for  the  palsy 
and  atrophy. 

lOCK-JAW. 

(Tetanus.) 

Description — When  a  patient  is  the  subject  of  an  imcontrollable 
spasmodic  contraction  of  the  muscles  of  the  lower  jaw,  he  is  said  to  have 
"trismus"  or  lock-jaw;  and  when  the  same  condition  attacks  other  or  all 
the  voluntary  muscles  of  the  body  ho  is  said  to  have  "tetanus." 

Causes — 1.  Tetanus  includes  trismus  and  generally  begins  with  it, 
though  trismus  may  be  a  local  affection.  It  is  found  in  children  as  a 
result  of  dentition,  and  in  adults  as  a  consequence  of  diseases  involving 
the  teeth,  gums  or  jaws.  It  is  a  spasmodic  affection  produced  by  reflected 
irritation  set  up  by  a  local  disease,  is  rarely  associated  with  any  con- 
stitutional disturbance  and  is,  for  the  most  part,  cured  on  removal  of 
the  cause. 

2.  Tetanus  is  likewise  generally  associated  with  some  local  source  of 
irritation,  some  wound  or  injury,  it  is  then  called  "traumatic;"  when  an 
external  or  visible  cause  can  be  made  out,  it  is  denominated  "idio- 
pathic ;"  when  rapid  in  its  coui'se  it  is  called  acute ;  when  slow,  chronic. 
The  acute  form  is  usually  the  result  of  an  accident  and  generally  fatal. 
The  chronic  is  for  the  most  jiart  idiopathic  and  more  curable. 

Symptoms. — There  are  no  general  or  local  premonitory  symjjtoms  by 
which  the  onset  of  this  affection  can  be  rccogiiized,  and  the  earliest  indi- 
cations of  its  approach  are  generally  a  difficulty  in  opening  the  mouth, 
with  stiffness  in  the  miiscles  of  the  lower  jaw ;  yet  these  symptoms  may 
be  so  slight  as  to  pass  unheeded,  or  to  be  misinterpreted,  when,  however, 
some  rigidity  of  the  muscles  of  the  neck,  throat  or  abdomen  can  be  made 
out  and  the  first  indications  of  the  "tetanic  grin"  recognized. 

3.  As  the  disease  progresses  the  muscular  system  of  the  body  gen- 


HTDEOPHOBIA,    OR   RABIES.  433 

erally  will  be  more  or  less  affected,  and,  in  different  cases,  different 
groups  of  muscles  will  be  involved.  Those  of  the  back  are  most  frequently 
attacked  and  their  contraction  may  be  so  powerful  as  to  cause  an  arching 
backward  of  the  frame.  The  muscles  of  respiration  are,  as  a  rule,  af- 
fected only  in  acute  cases,  and  the  chief  danger  to  life  consists  in  the 
severity  of  the  spasms  which  attack  them.  When  severe  the  first  spasm 
may  be  fatal  and  may  occur  at  an  early  or  at  a  remote  period  of  the 
affection.  When  the  jaw  is  unlocked  by  a  spasm  of  the  dejiressor  muscles, 
the  tongue  is  sometimes  suddenly  shot  out  from  between  the  teeth  and 
often  wounded. 

4.  As  the  disease  advances  the  jaws  become  completely  fixed  and 
deglution  is  then  impossible.  The  spasms  of  the  muscles  of  the  frame 
become  more  intense  and  frequent  and  the  powers  of  the  jjatient  rapidly 
decline.  The  pulse  which  was  rapid  becomes  more  feeble,  while  the 
expression  of  the  countenance  betokens  agony  of  the  body  and  despair 
of  the  mind.  The  slightest  manipulation  or  movement  of  the  patient 
sets  up  a  fresh  spasm,  and  any  emotion  may  do  the  same.  The  skin 
becomes  bathed  with  a  cold  sweat,  and,  if  death  is  not  caused  by  suffoca- 
tion, exhaiistion  soons  puts  an  end  to  suffering. 

Treatment. — Among  the  specific  remedies  which  have  been  greatly 
trusted  the  Calabar  bean  stands  foremost  and  may  be  given  in  full  doses, 
such  as  half  a  grain  of  the  extract  in  two  or  three  hours.  Camphor  is 
also  recommended  in  doses  of  from  five  to  ten  grains.  The  bromide  of 
ammonium  or  potassium  has  been  administered  with  advantage.  It  was 
hoped  that  a  valuable  drug  for  this  disease  had  been  found  in  chloroform, 
but  experience  has  not  jiistified  the  expectation.  The  hydrate  of  chloral 
has  now  taken  its  place  and  been  of  some  service.  Indian  hemp  in  doses 
of  a  grain  every  hour,  aconite  and  belladonna  in  qiiantities  of  one-fourth 
of  a  grain  have  also  been  recommended.  Ice  applied  in  bags  along  the 
spine  has  apparently  been  of  great  value.  The  administration  of  remedies 
by  subcutaneous  injection,  in  these  cases,  promises  to  be  a  valuable  ad- 
junct to  practice  enabling  us  rapidly  to  introduce  into  the  system  drugs 
which  act  antagonistically  to  tetanic  spasm.  Tetanus  antitoxine  should 
be  administered  early. 

HYDROPHOBIA,  OR  RABIES. 

Meaning   the    "dread    of   water,"    which    is   more   correctly    termed 
"rabies"  is  a  disease  contracted  from  a  rabid  animal,  generally  from  its 
bite  through  the  saliva  or  mucus. 
28 


434  NEEVOUS  DISEASES, 

Stages  of  the  Disease. — In  the  dog  there  are  three  well-marked  stages 
of  the  complaint.  The  first  is  the  melancholic,  characterized  by  melan- 
choly, depression,  sullenness  and  fidgetiness;  the  second,  the  furious,  by 
excitement  or  rabid  fury,  and  the  last,  ihe  paralytic,  by  general  muscular 
debility  and  actual  paralysis. 

Symptoms. — 1.  In  man  the  disease  may  show  itself  at  any  period  from 
six  weeks  to  a  year  after  the  inoculation.  A  month  or  more  after  the  bite 
of  a  mad  dog,  or  other  rabid  animal,  the  wound  having  healed,  irritation  is 
felt  in  it,  nervous  restlessness  also  exists  which  increases  (in  most  cases) 
to  violent,  angry  delirium.  Then  difficulty  of  swallowing  occurs  from  a 
spasm  of  the  muscles  of  inspiration  (gasping)  taking  place  at  the  moment 
of  deglutition,  making  the  patient  choke. 

2.  The  same  spasmodic  gasping  is  brought  on  by  any  sudden  im- 
pression, as  of  sound,  a  flash  of  light  or  even  a  current  of  air  passing 
over  the  face.  Insomnia  exists;  the  patient  gTows  prostrate  and  must 
die  for  want  of  food  and  drink,  even  if  the  affection  of  the  cerebro-spinal 
axis  were  not  itself  fatal. 

3.  There  is  intense  thirst,  but  the  characteristic  dread  of  water,  not 
as  a  fluid,  however,  but  as  connected  with  the  difficulty  of  drinking.  The 
sight  of  water  is  freqiiently  sufficient  to  bring  on  shuddering,  yet  it  is 
when  the  patient  carries  water  to  his  lips  that  he  is  seized  with  the  typical 
terrors. 

4.  A  rabid  man  is  always  rational  and  tries  to  drink,  but  the  attempt 
excites  terror  and  the  expression  of  his  inability.  His  eyes  become  fixed, 
features  contracted  and  his  countenance  expressive  of  the  deepest  anxiety, 
his  limbs  shake,  and  the  whole  body  shivers.  The  paroxysm  lasts  a  few 
seconds,  then  subsides,  but  only  to  be  renewed  on  the  slightest  breath  of 
air  touching  the  body.  During  the  calm  sudden  terror  of  an  unknown 
kind  haunts  the  mind  and  imaginary  calling  of  friends  often  exists. , 

Symptoms  of  last  Stage ^In  the  third  and  last  stage  the  longing  for 

drink  becomes  intense,  with  an  increasing  inability  to  take  it;  the  voice 
becomes  hoarse  and  the  mouth  full  of  frothy  fluid.  The  patient  tries  te 
get  rid  of  this  by  spitting,  and  then  becomes  frightened  at  its  results. 
Convulsive  seizures  increase  in  frequency  and  intensity,  the  spasm  of  the 
respiratory  muscles  threatening  life ;  at  last  a  fatal  spasm  takes  place  and 
death  by  asphyxia  ensues. 

Treatment — There  is  not  satisfactory  evidence  that  a  case  of  genuine 
rabies  canina  or  hydrophobia  has  ever  been  cured.  If  we  cannot  cure, 
what  can  or  should  we  do?     We  may  certainly  promote  easy  death  by 


INFANTILE   CONVULSIONS.  435 

allaying  the  wretched  sufferings  of  the  patient  by  nitrous  oxide,  ether, 
or  chloroform.  Hypodermic  injection  of  atropia  or  morphia  might,  per- 
haps, more  effectually  quiet  the  suffering  and  even  afford  more  possibility 
of  cure  than  inhalation  of  anesthetics.  In  all  cases  of  bites  from  dogs  or 
animals,  however,  in  which  the  faintest  suspicion  of  rabies  exists,  free 
cauterization  with  lunar  caustic  should  be  performed.  Mental  stimu- 
lants, in  the  way  of  inspiring  hope  and  removing  fear,  must  be  duly  ad- 
ministered and  such  general  treatment  as  may  be  needed.  No  drug  has 
yet  been  discovered  that  has  the  least  influence  on  the  disease,  either  in 
preventing  or  curing  it. 

What  is  known  as  the  "Pasteur  cure  for  hydrophobia"  is  in  gi-eat 
favor  among  some  medical  men.  It  is  rather  a  preventive  agent  or  treat- 
ment and  no  doubt  possesses  great  value. 

FITS  OR  INFANTILE  CONVULSIONS. 

Causes. — The  exciting  causes  are  numerous,  constipation  of  the 
bowels,  indigestion,  worms,  irritation  of  the  gums  in  teething  and  excite- 
ment of  the  brain,  as  by  fright,  are  about  the  most  frequent.  Many 
acute  and  chronic  diseases  of  infancy  (scarlet  fever,  meningitis,  whoop- 
ing-cough, and  so  forth)  have  convulsions  among  their  occasional  symp- 
toms or  complications. 

Symptoms — Premonition  of  a  fit  is  often  observed  in  the  child's  fret- 
fulness,  or  restlessness,  or  gritting  of  the  teeth  in  sleep.  When  a  fit  comes 
on  the  muscles  of  the  face  twitch,  the  body  becomes  rigid  at  first,  then  in 
a  state  of  twitching  motion,  the  head  and  neck  are  drawn  backward,  the 
limbs  violently  flexed  and  extended;  sometimes  these  movements  are  con- 
fined to  certain  muscles,  or  are  limited  to  one  side. 

Treatment — 1.  The  treatment  of  a,  child  during  the  convulsion  is,  of 
course,  to  be  directed  first  toward  relaxing  the  spasm,  and  immediately 
after  that  is  accomplished  to  removing  the  cause  of  the  trouble,  which,  in 
two  cases  out  of  three,  will  prove  to  be  irritation  of  the  gums  or  bowels. 
To  shorten  the  paroxysm  the  child  should  at  once  be  placed  in  a  warm 
bath  and  a  cloth  wrung  out  of  cold  water  applied  to  its  head. 

2.  If  the  gums  are  swollen,  or  have  been  tender  and  irritated  at  the 
time  of  teething,  lance  them  freely,  dividing  the  tense  gum  down  to  the 
coming  tooth.  If  the  bowels  have  not  been  moved  give  at  once  an  enema 
of  castor  oil,  soap  and  glycerine,  or  some  other  laxative  material,  with 
warm  water.     If  there  is  reason  to  suppose  that  the  intestinal  worms, 


436  NEEVOirs  dtseases. 

which  most  children  harbor,  are  causing  disturbance,  active  vermifuges 
such  as  a  grain  of  sautonino  before  dinner  and  supper  for  a  child  two 
years  old,  followed  by  two  grains  of  calomel  at  bed-time,  ought  to  be 
employed. 

3.  Cupping  the  back  of  the  neck,  in  some  cases  where  time  is  allowed 
by  a  protracted  fit,  may  be  resorted  to,  especially  dry  cups.  Full  doses  of 
bromide  of  potassium,  asafetida  and  valerian  are  often  very  useful  in 
diminishing  the  excitability  of  the  nervous  system,  which  is  especially 
great  during  the  age  of  childhood. 

PRESCRIPTION  NO.  i. 

R. — Bromide  of  ammonia    40  grains 

Bromide  of  potash    Ms  drachm 

Sy n-.p     I  ounce 

Water    i  ounce 

Half  a  teaspoonful  fur  a  child  2  years  old,  every  three 
or  four  hours. 

PRESCRIPTION  NO.  2. 

R. — Bromide    Soda     3  drachms 

Bromide   potash    3  drachms 

Liq.  potass,  ars i  Ms  drachms 

Peppermint   water    3  ounces 

Infus.   gentian   co 5  ounces 

Tablespoonful  three  times  a  day  for  an  older  child. 

FALITNG  SICKNESS  OR  EPILEPSY. 

Periodical  convulsions  with  unconsciousness  during  the  attack. 

Causes. — Hereditary  transmission  of  this  disease  is  common.  Intem- 
perance, venereal  excess  and  self-abuse,  blows  on  the  head  and  fright  are 
among  the  most  frequent  exciting  causes. 

Symptoms Premonition  occurs  in  a  minority  of  cases  before  an  at- 
tack; headache,  dizziness,  terror,  spectral  illusions,  a  creeping  or  blowing 
sensation,  like  that  of  a  current  of  air  or  stream  of  water,  beginning  in  a 
hand  or  foot  and  extending  toward  the  trunk.  Then,  often  with  a  scream, 
the  patient  falls  down  and  is  violently  convulsed.  Foaming  at  the  mouth, 
grinding  of  the  teeth  and  biting  of  the  tongue  are  common;  the  face  is 
flushed,  the  eyeballs  roll,  the  pupils  are  unaffected  by  light,  sometimes 
vomiting,  or  involuntary  urination  or  defecation  takes  place;  the  respira- 
tion may  be  very  laborious.     The  fit  lasts  on  an  average  from  five  to  ten 


SPASMODIC  CEOUP.  4:37 

minutes.  The  interval  between  the  attacks  may  be  from  several  mouths 
dowTi  to  a  few  days.  lu  old  cases  there  ma^'  be  two  or  three  paroxysms 
daily.  They  vary  much,  even  in  the  same  individual.  The  condition 
after  the  attack  is  also  various,  generally  drowsiness  or  deep  sleep  follows 
it,  or  headache,  debility  or  delirium,  sometimes  maniacal  frenzy. 

Treatment — 1.  During  the  paroxysm,  when  habitual,  little  can  be 
done.  Place  the  patient  so  that  he  cannot  strike  his  head  or  limbs  against 
anything  hard,  loosen  the  clothing  about  the  neck  to  form  free  respiration 
and  circulation  and  insure  fresh  air  about  the  patient,  protect  the  tongue 
from  being  bitten,  if  possible,  by  placing  a  cork  or  piece  of  India  rubber 
between  the  teeth.  Care  must  be  taken  that  such  an  object  does  not  pass 
into  the  throat  and  choke  the  patient,  which  can  be  prevented  by  tying 
a  strong  string  to  it. 

2.  To  break  up  the  recurrence  of  the  fits  is  the  problem  for  which  a 
vast  number  of  remedies  have  been  tried  in  vain.  Bromide  of  potash, 
valerianate  of  zinc,  belladonna,  arsenic  and  digitalis  have  all  been  em- 
ployed. Strangely  enough  this  disease  is  v.ei*y  apt  to  improve  temporarily 
under  any  new  treatment,  no  matter  how  absurd,  which  takes  a  strong 
hold  on  the  jjatient's  imagination. 

3.  Self-management  is  very  imiDortant  to  the  epileptic.  Temperance 
with  nutritious  diet  is  necessary ;  regularity  of  the  evacuation  of  the  bowels 
is  imperative ;  abundant  exercise  in  the  open  air,  short  of  exhaustion,  does 
good;  systematic  gymnastics  have  even  cured  some  cases. 

PRESCRIPTION. 

R. — Bromide  of  potash   3  drachms 

Bromide  of  soda    3  drachms 

Bromide  of  ammonia   3  drachms 

Iodide  of  potash    l'^  drachms 

Iodide    of   ammcnia    I  %  drachms 

Tincture  of  columb:;;  i  %  ounces 

Water     6  V4  ounces 

Take  two  teaspoonfuls  before  each  meal  and  three  tea- 
spoonfuls  at  bcJ-tirae. 

SPASMODIC  CROUP  OR  SPASM  OF  THE  GLOTTIS, 

Causes. — This  is  the  most  important  of  several  varieties  of  simple 
spasm  in  different  parts  of  the  body,  among  which  ordinary  croup  is  a 
familiar  example.    It  consists  in  a  spasm  of  the  muscles  of  the  glottis  or 


i38  NERVOUS  DISEASES. 

opening  into  the  windpipe,  by  which  a  crowing  or  croupy  cough  is  pro- 
duced, with  hard  or  stridulous  breathing. 

Symptoms. — This  disease  especially  occurs  in  young  children,  where 
it  is  due  to  some  reflex  irritation,  such  as  that  of  teething,  reflected  from 
the  nerve  centres  which  control  the  muscles  of  the  glottis.  It  may  gener- 
ally be  distinguished  from  the  alai'ining  malady,  true  croup,  by  its  coming 
on  suddenly  without  fever,  marked  heat  of  skin  or  quickened  pulse. 

Treatment. — To  relax  tlio  spasm  sprinkling  of  a  little  cold  water  in 
the  face,  or  tickling  the  fauces  with  the  finger  or  with  a  feather,  so  as  to 
produce  vomiting,  frequently  answers  the  pvirjiose.  Should  it  fail  the 
child  should  be  immediately  placed  in  a  warm  bath.  After  an  attack 
the  gums  should  be  carefully  examined  and  freely  lanced  if  found  swol- 
len, every  attention  being  paid  to  the  general  health.  Much  needless 
alarm  would  be  spared  to  anxious  parents  and  nurses  If  it  were  generally 
understood  that  there  is  no  likelihood  of  tliis  disease  leading  on  to  the 
fatal  malady,  true  croup,  which  may  always  be  excluded  from  considera- 
tion if  the  child  is  free  from  fever,  coughs  loudly  and  has  no  huskiness  of 
the  voice.    Give  syrup  of  ipecac  frequently  until  vomiting  takes  place. 

CHOREA  OR  ST.  VITUS'  DANCE. 

Causes. — From  six  to  sixteen,  in  both  sexes,  especially  often,  how- 
ever, in  girls,  chorea  occurs.  Nervous  debility  is  almost  always  present 
before  the  attack.  Fright  is  a  frequent  cause,  overfatigue  or  mental  ex- 
citement, blows  or  falls  may  produce  it.  Rheumatic  fever  is  sometimes 
followed  by  it. 

Symptoms — Incessant  and  irregxilar  movements  of  the  voluntary 
muscles  over  Avhich  the  will  has  but  partial  control.  Walking  in  severe 
cases  is  difiicult  or  unsafe ;  the  hands  cannot  be  regulated  enough  to  write 
or  work;  speech  may  be  affected;  the  muscles  of  the  face  often  twitch 
grotesquely.  The  pupil  is,  in  some  cases,  unnaturally  dilated ;  palpitation 
of  the  heart  may  occur,  and  also  constipation  and  indigestion.  The  urine 
is  of  great  density;  the  countenance  assumes  a  blank  and  foolish  expres- 
sion, and  the  mind  itself  may  iu  time  grow  seriously  enfeebled. 

Treatment — Good  diet,  salt  bathing  and  systematic  gymnastic  exer- 
cises will  suffice  for  mild  cases.  Where  marked  anemia  exists  iron 
(citrate,  phosphate  or  hypophosphate,  tincture  of  chloride,  syrup  of 
iodide)  is  important.  Obstinate  cases  may  be  treated  with  Fowler's 
solution  of  arsenic,  in  small  doses,  gradually  increased.      Cod-liver  oil 


HYSTEEIA.  439 

should  be  given  if  great  debility  exists.  In  chronic  cases  the  tonics  before 
mentioned  vnth  the  addition  of  the  hypophosphites  should  be  resorted  to, 
and  change  of  climate  is  very  likely  to  be  of  service. 

HYSTERIA. 

From  its  occurrence  nearly  always  in  females  and  from  a  supposition 
of  its  originating  in  some  affection  of  the  womb,  this  name  has  been  given 
to  a  variable  disorder,  of  which  the  main  characteristic  is  morbid  ex- 
citability of  the  whole  nervous  system. 

Symptoms — 1.  A  "fit  of  hysterics"  is  a  paroxysm  whose  natiire  may 
vary  from  mere  uncontrollable  laughter  or  crying  to  a  severe  epiliptiform 
convulsion.  This  last,  however,  differs  from  epilepsy  in  that  being  les3 
complete  loss  of  consciousness  and  in  its  curability. 

2.  Simulation  of  other  diseases,  indeed  the  assumption  of  severe 
functional  disorders  of  different  organs,  is  a  common  trait  of  hysteria. 
There  may  be  hysterical  amaurosis ;  hysterical  insanity  is  not  uncommon ; 
nor  is  hysterical  paralysis  or  coma  rare.  Retention  of  urine,  coughj 
aphonia,  and  so  forth,  are  often  thus  produced. 

Catalepsy. — Catalepsy  or  trance  is  a  condition  allied  to  hysteria  in 
some  respects,  in  which  the  whole  frame  lies  prostrate  and  helpless,  or 
that  a  limb,  lifted  up,  falls  back  as  if  it  were  relaxed  and  dead  while 
yet  the  consciousness  of  the  person  affected  may  be  retained  without  the 
sensitiveness  to  physical  pain.  This  curious  state  of  existence  is  not  well 
understood,  and  in  our  present  ignorance  of  its  nature  the  chief  importance 
lies  in  its  being  distinguished  from  death  early  enough  to  prevent  that 
most  horrible  of  all  human  misfortunes,  being  buried  alive. 

Hypochondriasis. — This  is  a  very  obstinate  affection,  often  hereditary, 
and  occurring  more  frequently  in  meii  than  in  women.  During  the  attack 
there  is  apparently  great  depression  of  mind  without  mental  disease.  The 
patient  imagines  he  is  afEicted  with  maladies  of  the  most  varied  kinds; 
is  tormented  with  ideas  of  impending  miseries  and  dangers;  thinks  he 
suffers  from  swellings  or  contortions  of  the  body,  which  may  be  purely 
creations  of  fancy.  This  disorder  in  the  male  corresponds  very  nearly 
to  hysteria  in  the  female  and  like  it  can  only  be  cured  by  attention  to  the 
general  health.  Tonics,  exercise  and  cheerful  occupation  are  the  best 
remedies. 

Treatment  of  Hysteria — Much  skill  and  care  will  often  he.  required 
in  the  management  of  hysteria,  as  each  one  has  peculiarities  of  its  own. 


440  NERVOUS  DISEASES. 

Generaly  a  tonic  regimen  is  demanded.  Iron  and  cod-liver  oil  are  most 
often  the  apjjropriate  remedies.  Bromide  of  potassium  is  sometimes  quite 
useful.  For  a  paroxysm  of  '"hysterics"  asafetida  is  universally  safe  and 
reliable  in  pills  of  three  grains  each.  Sinapisms  and  pediluvia  are  also 
proper.  Menstruation  is  often  irregular  in  hysterical  women ;  it  should  be 
regulated  as  far  as  possible.  Exercise  iu  the  open  air,  as  a  rule,  is  very 
important  for  such  persons.  Mental  and  emotional  excitement  should  bo 
avoided ;  but  tranquil,  even  engrossing,  occupations  wiU  be  beneficial.  For 
hysterical  paralysis  electricity  is  promptly  useful.  Cold  bathing,  espe- 
cially the  shower-baths  or  sea-bathing,  when  followed  by  reaction,  will  do 
good. 

NEUEALGIA. 

Meaning — Pain,  without  inflammation  or  other  disorder,  except  that 
of  the  nerve  or  nerve-control  involved;  literally  neiwe  pain.  This  may 
affect  any  of  the  sensitive  nen-os.  It  is  also  sometimes  referred  to  parts 
which  have,  in  health,  no  sensibility;  as  the  heart,  stomach,  and  so  forth. 
Different  names  are  given  according  to  its  site.  Thus,  tic  doiileureux  is 
facial  neuralgia;  hemicrania,  that  affecting  one  side  of  the  head;  sciatica, 
that  of  the  hip ;  gastrodynia,  neuralgic  pain  in  the  stomach ;  pleurodynia, 
in  the  side.     Angina  pectoris  is,  chiefly,  a  neuralgic  affection  of  the  heart. 

Symptoms. — The  pain  is  generally  acute,  shooting  or  darting,  with 
tenderness  of  the  part  upon  pressure.  There  is,  however,  no  heat  or 
swelling,  or  throbbing  of  the  blood-vessels  in  pure  neuralgia.  Complicated 
eases  occur  in  which  inflammation  and  neuralgia  exist  together,  and  in- 
flammation of  the  fibrous  neurilemma  may  be  the  immediate  cause  of  the 
neuralgic  pain. 

Causes. — ISTeuralgia  is  always  dependent  upon  debility  arising  from 
one  cause  or  another,  as,  for  instance,  anemia,  mental  anxiety,  gout,  rheu- 
matism, syphilis  and  dyspepsia.  In  fact,  a  great  German  authority  upon 
nervous  diseases  declares,  with  as  much  truth  as  poetry,  that  "neuralgia 
is  the  prayer  of  the  nerves  for  iron  in  the  blood." 

l^ext  to  the  sciatic  nerve  no  other  is  so  often  the  seat  of  neuralgic 
pain  as  the  trifacial,  and  this  is,  perhaps,  partly  owing  to  the  fact  that 
the  superficial  branches  are  spread  out  over  a  large  surface  upon  the  side 
of  the  face  and  more  exposed  to  cold  and  changes  of  the  weather  than  any 
other  part  of  the  body  where  the  epidermis  is  equally  delicate.  Terminal 
branches  of  the  trifacial  come  out  through  the  bones  of  the  head  at 
points  over  the  eye,  beneath  the  eye  and  at  the  side  of  the  chin — as  shown 


UEUEALGIA. 


441 


in  the  marginal  illustration.  These,  then,  are  the  tender  points,  where  all 
the  branches  of  this  nerve  are  involved  in  the  neuralgia,  and  it  is  from 
these  points  that  the  darting  bony  pains  seem  to  radiate. 

Hemicrania  or  Migraine. — This  is  a  combination  of  neuralgic  symp- 
toms with  ordinary  headache  occurring  in  paroxysms,  and  usually  limited 
to  one  side  of  the  head  or  brow.  It  is  ajit  to  conuiience  in  childhood  and 
go  on  to  advanced  age,  occurring  in  both  sexes,  but  more  often  in  women 

than  in  men.  In  women  the 
attacks  are  especially  apt  to 
appear  just  before  the  men- 
strual period  or  during  its 
course. 

Causes — The  headache 
is  probably  due  to  excitement 
of  the  sensitive  filaments  of 
the  trifacial  nerve — distri- 
buted to  the  dura  mater — 
and  also  to  the  sympathetic 
fibres  accompanying  the 
blood-vessels,  which  connect 
the  nervous  supply  of  the 
brain  with  that  of  the 
stomach  so  intimately. 

Symptoms. — As  gener- 
ally manifested  it  increases 
rapidly  soon  after  waking  in 
the  morning,  with  chilliness, 
loss  of  appetite,  sliminess  of 
the  mouth,  sickness  of  the 
stomach,  vomiting  of  a  little  greenish  fluid,  and  at  last  the  headache  be- 
comes so  intense  as  to  be  almost  nnlx^arable. 

Sciatica. — This  is  often  associated  with  both  rheumatism  and  gout, 
but  is  also  frequently  brought  on  by  catching  cold.  Occasionally  it  is  due 
to  accumulations  in  the  bowels,  or  to  diseases  of  the  Ixjnes  through  whicli 
the  nerve  makes  its  exit.  The  painful  points  are  usually  found  back  of  the 
trochanter  or  most  projecting  point  of  the  thigh  bone,  at  certain  spots  in 
the  thigh  about  the  knee  and  ankle  joints. 

Intercostal  Neuralgia — This,  like  intercostal  rheiunatism,  resembles 
the  pain  of  pleurisy  and  of  pneumonia,  and  has  often  given  rise  to  un- 


Distrlbutlon  of  Nerves  on   the  Side  of  the  Face. 


433  NEEVOUS  DISEASES. 

founded  anxiety  as  to  the  existence  of  these  more  dangerous  diseases.  It 
may  be  at  once  distinguished  by  careful  examination  of  the  lungs. 

Neuralgias  of  the  arms,  neck,  shoulder,  and  so  forth,  are  unhappily 
common  and  sometimes  very  intractable. 

Pathology. — At  least  three  soiirces  of  pain  are  possible.  1st.  Local 
disease  aifecting  a  nerve.  2d.  A  morbid  state  of  a  sensorial  nerve  centre. 
3d.  A  morbid  condition  of  the  blood.  Neuralgia  always  fixed  or  return- 
ing in  the  same  spot,  is  likely,  although  not  certain,  to  depend  upon  a 
fault  in  the  nerve  itself,  as  neuroma  (tumor  of  a  nerve).  Radiating  pain 
must  at  least  involve  part  of  a  nerve  centre.  Flying  pains,  never  long 
seated  in  one  part  of  the  body,  are  due  to  a  defect  or  morbid  poison  (as 
that  of  gout  or  malaria)  in  the  blood. 

Treatment  of  Neuralgia. — 1.  This  must,  of  course,  depend  upon  the 
cause  or  nature  of  the  case.  Tic  douleureux  often  depends  upon  decay 
of  the  teeth;  if  so,  they  miist  be  attended  to.  Other  purely  local  neu- 
ralgias require  local  treatment.  Laudanum  or  paregoric,  applied  by  satu- 
rating a  cloth  and  laying  it  upon  the  part  covered  by  oiled  silk  to  prevent 
evaporation,  is  an  efficient  local  anodyne.  So  is  chloroform,  similarly  ap- 
plied; it  is  very  pungent,  burning  like  mustard.  Sinajjisms  will  some- 
times relieve  promptly. 

2.  Mere  warmth,  as  of  flannel  steeped  in  hot  water,  will  do  in  some 
instances.  Rubbing  for  a  few  moments  with  saturated  tincture  of  aconite 
root  until  the  skin  tingles,  or  the  application  of  ointment  of  veratria, 
twenty  grains  to  the  ounce  of  vaseline,  may  be  used  in  severe  cases.  In 
the  most  obstinate  ones  a  blister  may  be  applied,  dressed,  after  removal 
of  the  cuticle,  with  two  grains  of  the  acetate  of  morphia,  diluted  with  ten 
grains  of  gum  arable.  Carbolic  acid  is  a  powerful  local  anesthetic,  though 
(unless  diluted  with  oil  or  glycerine)  very  irritating  to  the  skin ;  or,  most 
prompt  usually  of  all,  solution  of  morphia  may  be  hypodermically  injected. 

3.  Of  anodynes  internally  used,  belladonna  has,  for  neuralgia,  the 
greatest  reputation.  It  will  not  quell  suffering  so  directly  as  opium  or 
morphia,  but  it  will  more  entirely  do  away  with  the  neuralgic  state.  For 
this,  however,  iron,  especially  in  combination  with  quinine  or  strychnia, 
is  the  most  effective  medicine.  Cases  of  neuralgia  which  will  not  be 
benefited  by  iron  are  decidedly  exceptional 

4.  In  some  instances  application  of  the  galvanic  current  will  remove 
the  pain  of  neuralgia  as  if  by  magic,  and  when  relief  can  thus  be  secured 
it  is  far  preferable,  as  tlie  distressing  sickness,  headache  and  qonstipation, 
which  so  often  result  from  opium  and  other  narcotics,  may  thus  be  avoided. 


DELrEITTM  TREMENS.  443 

Auxiliary  Treatment — The  hygienic  treatment  is  almost  equally  im- 
portant with  the  medicinal,  and  a  thorongh  examination  of  the  habits  of 
life  pursued  by  the  patient  will  almost  always  lead  to  the  discovery  of 
some  violation  of  sanitary  law,  which  must  be  corrected  before  a  hoped- 
for  cure  can  be  realized. 

PRESCRIPTION   I. 

R. — Menthol    20  grains 

Ext.    Belladonna     5  grains 

Chloral    5  grains 

Vaseline     3  drachms 

Apply  the  ointment  to  face  where  pain  is  seated. 

PRESCRIPTION  2. 

R. — Citrate    of   caffeine    ic  grains 

Phenacetine     %  drachm 

Make  ten  capsules.     Take  one  every  2  or  3  hours. 

PRESCRIPTION  3- 

Tablets  acetanilide  and  sodium  bromide.    One  as  needed 
every  three  or  four  hours. 


DELIRIUM  TREMENS. 

Causes  may  arise  imder  two  different  conditions  or  circumstances. 
Where  stimulants  are  suddenly  withdrawn  from  one  accustomed  to  them; 
and,  while  their  use  in  excess  is  continued. 

Symptoms. — Sleeplessness,  debility,  tremors,  horror,  hallucinations, 
often  with  loss  of  digestive  power.  The  insomnia  is  a  cardinal  symptom ; 
if  the  patient  sleeps  a  whole  night  he  recovers.  Debility  varies  in  degree 
in  different  cases ;  in  a  first  attack  it  is  not  always  great,  tremor  is  nearly 
always  present.  The  illusions  of  the  patient  are  wonderfully  real,  and 
usually  dreadful.  He  is  pursued  by  demons  or  beset  by  moral  enemies; 
he  cannot  bear  to  be  alone,  especially  in  the  dark.  Sometimes,  however, 
the  visions  are  indifferent,  or  even  amusing. 

Treatment — If  the  patient  be  not  much  prostrated,  give  only  ale  or 
porter,  a  bottle  or  two  in  the  day,  with  hop  tea  ad  libitum  and  a  grain  of 
opium  every  three  or  four  hours.  Very  weak  patients,  accustomed  to 
spirits,  might  have  a  tablespoonful  of  whiskey  or  brandy  every  two,  three 
or  four  hours,  according  to  their  condition.    Hydrate  of  chloral  sometimes 


444  NERVOUS  DISEASES. 

answers  as  well  as,  or  better  than,  opium.     Bromide  of  potash  with  tinc- 
ture of  hyoscyanus  repeated  every  three  to  four  hours. 

Diet. — Beef  tea  and  mutton  broth,  and  so  forth,  seasoned  with  red 
pepper,  are  preferred  as  diet.  In  an  obstinate  case  sleep  may  follow  the 
raising  of  a  blister  upon  the  back  of  the  neck.  Substituting  valerian  for 
opium,  or  combining  the  fluid  extract  or  tincture  of  valerian  with  morphia 
solution  answers  well  in  some  cases.  Injection  of  laudanum  into  the 
rectum  is  occasionally  resorted  to.  Success  in  treatment  has  been  ob- 
tained from  the  use  of  chloroform  in  doses  of  one  or  two  drachms.  The 
corrugated  stomach  of  a  sj^irit  drinker  will  probably  bear  the  pungency 
of  chloroform  better  than  anetheis.  The  large  majority  of  first  attacks 
of  mania-a-potu  are  curable.  Third  and  fourth  attacks  are  often  fatal,  or 
are  followed  by  permanent  insanity. 

PRESCRIPTION   I. 

R. — Indian    hemp    lo  grains 

Divide  into  12  pills.    Take  one  every  two  or  three  hours 
until  drowsy. 

PRESCRIPTION   2. 

R. — Hyoscyamus     I  grain 

Alcohol     I  drachm 

Water     I  drachm 

Inject  5  to  10  minims  with  hypodermic  syringe. 

INSANITY  OR  MADNESS. 

Causes — 1.  This  consists  chiefly  in  a  particular  organization  of  the 
brain  and  nervous  system,  rendering  those  individuals  so  constituted 
liable  to  become  insane  when  exjiosed  to  the  influence  of  certain  agencies, 
which  in  other  persons  either  give  rise  to  a  different  train  of  morbid 
phenomena,  or  are,  perhaps,  devoid  of  any  injurious  effects. 

2.  Among  the  agents  which  give  rise  to  madness  there  is  none  more 
influential  than  intemiierance,  or  the  frequent  use  of  ardent  spirits.  That 
the  predisposition  to  madness,  when  it  has  once  arisen,  is  frequently  trans- 
mitted, is  a  fact  too  well  established  to  admit  of  doubt. 

3.  The  exciting  causes  of  insanity  may  be  divided  into  moral  or 
psychical  and  physical.  The  principal  psychical  are  grief,  fright,  anxiety, 
care,  or  an  excited  state  of  any  passion ;  the  emotions  aroused  by  disap- 
pointment, excessive  or  prolonged  employment  of  the  intellectual  facul- 
ties, and  so  forth.     Anything  which  will  produce  a  hyperemia  of  a  por- 


INSANITY  OB  MADNESS.  445 

tion  or  the  whole  of  the  brain  by  which  the  nutrition  and  consequently 
the  normal  function  is  interfered  with. 

4.  The  principal  i>hysical  causes  are  drunkenness  and  the  use  of 
narcotic  or  poisonous  drugs,  want  of  food,  want  of  sleep  and  over-exertion ; 
other  nervous  diseases  such  as  epilejisy,  chorea  and  hysteria;  severe  in- 
juries to  the  head,  particularly  from  blows,  causing  fracture  of  the  skull 
or  concussion  of  the  brain,  sunstroke  and  tumors  in  the  brain.  Acute 
febrile  diseases  as  typhoid,  typhus  and  malarial  fevers,  and  it  may  occur 
during  the  course  of  jmeumonia  in  the  form  of  acute  mania.  The  poison 
of  Asiatic  cholera  may  so  interfere  with  the  nutrition  of  the  brain  as  to 
produce  not  only  transient  delirium  but  mania,  which  may  continue  sev- 
eral days  or  weeks.  Acute  rheumatism  is  sometimes  a  cause,  chronic  con- 
stitutional diseases  are  frequent  causes,  and  among  the  most  formidable 
of  these  is  constitutional  syphilis.  Diseases  of  the  genital  organs  some- 
times exert  an  important  influence  in  producing  insanity. 

Symptoms — 1.  The  earliest  symptoms  of  coming  insanity  are  de- 
pressed manner,  unusual  excitement,  anger  and  rashness. 

2.  An  important  symptom  in  all  forms  of  insanity  is  impairment  of 
the  faculty  of  attention.  The  inconsistency  of  the  beliefs  of  the  insane  is 
one  of  the  earliest  noticeable  symj^toms,  and  they  are  classed  as  "delu- 
sions" and  "hallucinations."  A  delusion  is  a  false  belief  in  regard  to  some 
fact  which  generally  concerns  the  patient,  and  which  is  so  strongly  rooted 
that  all  attempts  to  reason  him  out  of  it  are  futile.  A  hallucination  is  a 
false  perception  of  one  of  the  senses ;  the  patient  may  fancy  that  he  sees 
a  spirit  or  a  person  who  does  not  exist. 

iMelancholia — This  may  be  acute  or  chronic,  and  is  marked  by  ex- 
treme depression  of  both  mind  and  body.  The  first  stages  of  melancholia 
are  generally  preceded  by  a  condition  called  hypochondriasis,  which  may 
be  considered  as  the  mildest  form  of  insanity.  There  is  a  feeling  of 
bodily  illness  at  this  time  more  than  at  any  other,  or  in  any  other  form 
of  insanity. 

Treatment. — 1.  The  treatment  of  a  case  of  chronic  or  subacute  melan- 
cholia will  vary  with  its  history  and  symptoms.  An  asylum  is  not  indis- 
pensable if  the  patient's  means  are  sufficient  to  provide  him  with  proper 
care.  He  may  be  benefited  by  travel  and  change  of  scene ;  but  when  his 
condition  will  not  admit  of  this  a  proper  place,  either  a  private  house  or  an 
asylum,  should  be  selected,  and  an  attempt  made  by  therapeutical  and 
hygienic  measures  to  restore  the  cerebral  defect  by  sleep  and  nourishment 
of  the  body. 


456  NEEVOUS  DISEASES. 

2.  There  are  three  conditions  which  require  constant  attention :  want 
of  sleep,  rejection  of  food  and  constipation.  To  remedy  tlie  first  chloral 
is  most  beneficial.  The  practical  aim  is  to  produce  sleep,  regularity  of  the 
evacuations  by  laxative  medicines  and  to  sustain  the  strength  with  nourish- 
ing food  and  wine. 

Mania. — There  are  two  varieties,  the  acute  and  chronic.  In  the  acute 
form  the  excitement  is  extreme,  and  follows  closely  \ipon  the  delusion  or 
derangement  of  ideas.  In  the  chronic  form  the  delusion  or  derangement 
is  confirmed  but  less  obtrusive,  while  the  excitement  is  subdued  or  comes 
on  at  long  intervals.  Mania  has  generally  a  sort  of  stage  of  incubation, 
during  which  sleeplessness  is  one  of  the  most  important  and  earliest 
symptoms.  In  another  class  of  patients  the  primary  symptoms  are  those 
of  gloom  and  despondency,  out  of  which  the  maniacal  excitement  appears 
to  develop.  In  both  varieties  there  is  generally  a  marked  departure  from 
the  individual's  usual  state  of  physical  health.  The  difPerent  forms  of 
mania  in  which  the  disposition  to  commit  murder,  suicide  or  arson,  or  to 
steal,  is  quite  uncontrollable,  are  well  known.  "When  a  single  tendency  of 
this  kind  is  very  prominent  the  case  is  usually  denominated  one  of 
monomania. 

Treatment — The  treatment  consists  on  regulating  the  bodily  fimc- 
tions,  giving  food  freely,  combined  with  plenty  of  drink,  also  wine,  and  in 
the  judicious  use  of  chloral.  Kest  is  of  the  highest  importance,  and  baths 
of  warm  water  are  of  great  benefit,  the  head  to  be  kept  cool  during  the 
operation.  Purgatives  at  the  outset  of  the  attack  may  be  of  use,  as  aiding 
to  arrest  it. 

PRESCRIPTION. 

R. — Fluid  extract  of  conium    i  %  drachms 

Fluid  extract  of  hyoscyamus    i  '-4  drachms 

Hydrate   of   chloral    2%  drachms 

Syrup   of   orange   peel    I  Mt  ounces 

Take  a  teaspoonful  every  two  or  three  hours,  as  occa- 
sion requires. 

Dementia — Dementia  is  literally  a  want  of  mind,  and  the  word  indi- 
cates a  condition  in  which  there  is  feebleness  of  intellectual  grasp,  or 
attention,  imbecility  of  word  and  act  and  general  deficiency  of  mental 
power.  It  is  one  of  the  common  terminations  of  both  mania  and  melan- 
cholia, and  if  long  continued,  its  outward  signs  are  a  vacant  and  puzzled 
look,  a  laclc-lustre  eye,  a  weak  smile  and  a  meaningless  laugh.  This  kind 
of  insanity  is  almost  a  natural  termination  of  extreme  old  age  and  is  then 


iraUEASTHENIA.  447 

called  senile  dementia.  Not  infrequently  the  subjects  o£  it  become 
paralytic. 

Imbecility — Imbecility  is  a  condition  in  -wbich  the  mind  is  from 
birth  unfitted  for  the  active  and  thoughtfid  duties  of  life,  and  in  which 
the  person  affected  is  said  to  be  half-witted,  or  wanting  in  general  in- 
telectual  capacity.  This  condition  of  deficient  mental  development  may 
be  associated  with  moderately  good  physical  health  in  early  life,  but  there 
seems  to  be  usually  some  taint  in  the  system,  so  that  the  family  of  im- 
beciles is,  as  a  rule,  short-lived,  the  members  dying  early  of  consumption, 
diabetes,  or  of  some  degeneration  of  the  brain  and  spinal  cord. 

Idiocy — ^Idiocy  is  a  still  lower  grade  of  mental  weakness,  in  which 
the  intellectual  faculties  are  below  the  standard  necessary  for  reasonable 
life.  In  the  true  idiot  the  head  is  of  a  reduced  size  and  the  appetites  and 
propensities  are  very  little,  or  not  at  all,  controlled  by  reason.  Many 
idiots  are  deaf  and  dumb,  but  most  of  them  retain  their  sight.  The  sad 
condition  of  these  poor  creatures  may  be  often  ameliorated  by  systematic 
training,  but  complete  cure  after  jjuberty  is  hopeless. 

Treatment  of  Insanity. — The  treatment  of  insanity  is  generally  best 
carried  out  in  asylums  for  the  purpose.  To  quiet  a  patient  temporarily, 
or  on  his  way  to  a  suitable  institution,  bromide  of  potassium  in  quantities 
of  thirty  grains,  or  chloral  in  fifteen-grain  doses  every  two  or  three  hours, 
morphia  by  hypodermic  injection,  or  otherwise,  and  even  chloroform  by 
inhalation  may  be  necessary. 

NEURASTHENIA. 

Neurasthenia,  sometimes  referred  to  as  spinal  irritation,  nervous 
exhaustion,  etc.,  is  a  functional  condition  of  the  nervous  system,  causing 
a  lessened  desire  to  perform  or  attend  to  the  various  duties  of  life. 

Causes — Heredity  is  sometimes  a  factor;  it  may  be  an  outcome  of 
various  chronic  diseases ;  nervous  temperament ;  overwork ;  sexual  excesses ; 
alcoholism ;  excessive  use  of  tobacco,  etc. 

Symptoms — Neurasthenia  may  affect  any  organ  of  the  l)ody.  One 
of  the  earliest  manifestations  is  a  weakness  of  the  mental  faculties  in 
not  being  able  to  .concentrate  the  tbotights,  endeavoring  to  do  so  bringing 
on  headache,  fear,  feelings  of  weakness  and  depression,  palpitation  of  the 
heart,  coldness  of  the  bands  and  feet  and  chilliness,  often  followed  by 
flashes  of  heat.  In  males  genito-urinary  disorders  frequently  occur  with 
dread  of  impotence.     In  females  painful  menstruation,  ovarian  irritation 


448  NEEVOUS  DISEASES. 

aud  irritable  uterus  are  frequently  present.  Care  should  be  taken  in 
diagnosing  to  distinguish  between  neurasthenia,  or  true  nervous  exhaus- 
tion, and  nervous  debility  accompanying  some  organic  disease. 

TkriVtment. — Sight  must  not  be  lost  of  the  fact  that  the  patient  is  a 
sick  individual  and  should  have  rest,  quiet  and  good  food.  Pleasant  com- 
panionship and  relief  from  responsibility  arc  essential  iind  where  possible 
travel  is  especially  recommended,  care  being  taken,  however,  that  the 
patient  does  not  become  fatigued.  Among  the  internal  remedies  of  value 
are  arsenic,  strychnia,  the  valerianates,  Pil.  Carm-Allen  and  the  hypo- 
phosphites. 

Neuritis — Simple  neuritis,  an  inflammation  of  the  nerve  trunk,  char- 
acterized by  pain  (often  severe),  impaired  sensation  and  atrophy.  Among 
the  principal  causes  may  be  included  wounds,  injuries  and  compression 
of  the  nerves,  exposure  to  cold  or  wet,  rheumatism,  syphilis.  Tlie 
affected  nerve  is  red  and  swollen;  the  fibres  have  undergone  some  granu- 
lar change.  The  inflammation  may  extend  upward  or  downward.  In 
long  standing  cases  the  diseased  nerves  are  found  to  be  made  up  largely 
of  connective  tissue  replacing  the  degenerated  structure.  The  most  de- 
cided symptom  is  pain,  with  tenderness  along  the  course  of  the  nerve 
trunk,  of  a  burning,  tingling,  tearing  and  often  intense  character,  in- 
creased by  pressure  or  motion.  Sometimes  contractions  and  muscular 
cramps  occur,  followed  by  impaired  motion.  The  prognosis  is  favorable 
with  proper  treatment. 

Treatment. — The  affected  part  should  be  placed  at  rest.  If  the  dis- 
ease is  severe,  blister  along  the  course  of  the  nerve.  Internally  full  doses 
of  iodide  of  potassium.  Sodium  salicylate  and  phenacetiue  are  often 
useful.  Locally,  sedative  lotions.  Leadwater  and  laudanum,  oil  of  tea- 
berry.  Various  liniments  often  relieve  the  intense  pain.  Syi^hilitic  cases, 
iodide  of  potassium  does  the  most  good.  If  due  to  rheumatism,  the 
salicylates  and  alkalies  are  indicated.  If  anemia  is  present,  iron  and 
hypophosphites  is  indicated. 


PART  IV  OF  BOOK  IV 

Treats  of  the  structure  and   diseases  of  the  eye,  ear 
and  nose. 


Abscess  in  the  Ear 480 

Treatment  of 480 

Acne  Rosacea   488 

Treatment  of 488 

Adenoids    489 

Amaurosis     463 

Treatment  of 463 

Anatomy  of  the  Ear  473 

of  the  Nose   483 

Aqueous  Humor,  Tlie  454 

Asthenopia   465 

Treatment   of    465 

Astigmatism     469 

Treatment  of 469 

Auditory  Canal   473 

Auricle,  Eczema  of  478 

Hematom.a  of   479 

Boils   480 

Bones  of  the  Nose   ». . .  .484 

Bony  Tumor  of  the  Ear  481 

Cartilages  of  the  Nose 484 

Cataract    463 

Catarrh     '. . .  485 

Fetid    487 

Nasal 4S5 

Catarrhal   Conjunctivitis   456 

Treatment  of  456 

Cerumen,    Impacted 481 

Choroiditis    463 

Treatment   of    463 

Conjunctivitis    455 

Catarrhal    456 

Diphtheritic   458 

Phlyctenular    456 

Cornea,   The    452 

Inflammation  of  459 

Crystalline  Lens   453 

Day-Blindness     470 

Treatment  of  470 

Diphtheritic    Conjunctivitis    458 

Treatment   of   459 


Drum,   Ear   476 

Ear,  Abcess  in   480 

Anatomy  of  473 

Bony  Tumor  of   481 

Diseases  of    473 

Drum,  The   476 

Perforation  of   482 

Thickening  of    483 

Foreign  Objects  in 477,  481 

Insects  in   477 

Tumors  of   478 

Earache   482 

Treatment  of 482 

Ear-Wax    476 

Eczema  of  the  Auricle   478 

Treatment   of    478 

Epistaxis    485 

Eustachian  Tube,  Innamniation  of.. 483 

Exostosis    481 

Treatment  of 481 

Eye,  The    451 

Socket,  The   451 

Structure  of  451 

Fetid  Catarrh  487 

Treatment  of   487 

Foreign  Bodies  in   the   Ear.... 481,  487 

Treatment  of 481 

Furunculosis    480 

Glaucoma    465 

Treatment  of  465 

Granulated   Eyelids    472 

Grape-like  Tumors    488 

Gutta  Seroma   463 

Hematoma  of  the  .A.uricle 479 

Treatment  of  479 

Hordeolum    471 

Impacted  Cerumen   481 

Inflammation  of  the  Cornea   459 

of  the  Eustachian  Tube   483 

of  the  Lachrymal  Gland 470 

Insects  in  the  Ear 477 


29 


449 


450 


INDEX  TO  PAET  IV  OF  BOOK  IV. 


Iris,  The  452 

Iritis   462 

Treatment  of 462 

Keratitis    459 

Treatment  of   459 

Labyrinth.  The   476 

Lachrymal  Gland,  Inflammation  Qf..470 

Lens,   Crystalline    453 

Mastoiditis    479 

Causes  of  479 

Treatment  of  479 

Membrane,  Schneiderian    484 

Myopia    466 

Treatment  of  466 

Nasal  Catarrh  485 

Causes  of  486 

Polyps    488 

Causes  of 488 

Treatment  of 488 

Nerve,  Olfactory   484 

Night-Blindness     470 

Causes  of   470 

Treatment  of  470 

Nose,  Anatomy  of 483 

Bleed    48S 

Causes  of  485 

Treatment  of   485 

Bones    484 

Cartilages    484 

Warts  on   489 

Objects  in  the  Ear   477 

Olfactory   Nerve,  The 484 

Ophthalmia    455 

Neonatorum     457 

Treatment   of    457 

Purulent    457 

Pustular     456 

Strumous    456 

Ossicles    476 

Ozena    487 

Perforation  of  the  Ear  Drum 482 

Causes  of   482 

Treatment   of    482 

Phlyctaenular   Conjunctivitis    456 


Polyps,  Nasal   488 

Pupil,  The   452 

Purulent  Ophthalmia  457 

of    Infants    457 

Treatment   of    457 

Pustular  Ophthalmia   456 

Treatment   of    456 

Retina,  The   451 

Structure  of 453 

Retinitis     462 

Causes  of   462 

Treatment  of    463 

Schneiderian  Membrane   484 

Sclerotic  Coat,  The   452 

Sclerotitis    462 

Treatment  of 462 

Semi-circular  Canals,  The   477 

Short-Sight    466 

Sight,   Weak    465 

Socket  of  the  Eye  451 

Squinting    471 

Causes  of   471 

Treatment  of  472 

Stirrup,  The   477 

Strabismus     471 

Strumous  Ophthalmia   456 

Stye : 471 

Treatment   of    471 

Trachoma    459,   472 

Treatment  of 459 

Trichiasis    471 

Tumors  of  the  Ear  478 

Bony    481 

Grape-like    488 

Tympanum,  The    476 

Vitreous  Humor,  The   454 

Wax    481 

in  the   Ear   476 

Plugs    476 

Treatment  of   481 

Warts  on  the  Nose  489 

Weak   Sight  465 

Wild    Hairs    471 

Treatment  of .471 


ILLUSTRATIONS 


Crystalline  Lens   454 

Curvature  of  Lens  466 

Ear.  The  472,  474 


Eye,  The 461 

Eye,  Section  of 452 

Operation  for  Cataract  464 


CURATIVE    MEDICINE 


PART   IV 
DISEASES  OF  THE  EYE,  EAR  AND  NOSE 

Importance  of  Subject. — The  diseases  of  the  eye  are  so  important,  and 
serious  injury  or  loss  of  the  organs  of  vision  is  such  a  terrible  misfortune, 
that  they  demand  a  careful  consideration.  For  the  better  comprehension 
of  this  group  it  will  be  needful,  however,  to  give  some  preliminary  ex- 
planation in  regard  to  the  eye,  and  also  the  ear  and  nose,  with  their 
appendages. 

Wonders  of  the  Eye. — The  eye  is  probably  the  most  wonderfully  in- 
genious and  complex  organ  of  the  human  body,  and  being  proportionately 
delicate,  requires  to  be  guarded  with  the  greatest  care.  Few  catastrophes 
are  more  grievous  than  that  of  total  blindness,  and  most  people  would 
rather  lose  all  the  other  senses  than  be  deprived  of  sight. 

Structure  of  the  Eye. — The  intricate  structure  of  the  eye  may  perhaps 
be  best  comprehended  if  we  remember  that  its  general  plan  is  that  of  a 
photogi'apher's  camera,  the  convex  glass  in  the  front  of  which  corresponds 
with  the  crystalline  lens  of  the  eye,  a  picture  of  external  objects  being 
formed  upon  the  artist's  ground-glass  plate  in  the  one  case,  and  upon  the 
retina  at  the  back  part  of  the  eyeball  in  the  other. 

The  Ketina — Now,  the  retina  is  simply  the  expanded  optic  nerve, 
which  has  the  peculiar  power  of  perceiving  lights  or  colors,  and  the  chief 
difference  between  the  eye  and  the  camera  is,  that  in  the  former  temporary 
impressions  only  are  perceived  by  the  brain,  through  the  optic  nerve  and 
retina,  and  in  the  latter  instrument  these  temporary  impressions  are  in- 
tended to  be  rendered  permanent  on  the  sensitive  plate  or  paper,  as  a 
photographic  picture. 

The  Eye  Socket The  eye  is  carefully  protected  from  accidental  in- 
jury by  being  embedded  in  a  deep  cavity  or  socket  in  the  solid  bones  of 
the  face  and  head,  which  guard  it  jealously  from  attack  on  either  side  and 
at  the  back.  This  socket  is  much  larger  than  the  eye  itself,  and  the  bony 
cavity  is  filled  up  behind  and  at  the  sides  of  the  eyeball  with  an  admirable 
cushion  and  packing  of  soft  fat, 

451 


452 


DISEASES   OF   THE   EYE,   EAE   AND   NOSE. 


The  Cornea. — The  eye  itself,  as  can  be  readily  seen  in  that  of  a  pig  or 
sheep  from  a  butcher's  shop,  is  a  white  ball  almost  exactly  round,  except 
■where  the  clear  circle  projects  a  little  in  front.  This  clear  part,  called  the 
cornea  (1),  is  as  transparent  as  glass,  and  set  in  the  space  made  for  it  in 
the  white  part  of  the  eyeball,  very  much  as  a  watch  crystal  is  set  in  its 
frame.  The  white  portion  of  the  ball,  called  the  sclerotic  coat  (2),  is  a 
tough  membrane,  very  strong  and  dense,  which  gives  shape  to  the  organ 
of  vision,  and  protects  the  extremely  delicate  structures  within.  The 
cornea  and  sclerotic  coat  each  average  about  one-twentieth  of  an  inch 
in  thickness. 

The  Iris — Inside  of  the  cornea  is  a  circular  curtain,  with  a  round  hole 
in  the  middle,  called  the  iris  (7),  so  named  because  it  varies  so  much  in 
color,  being  frequently  blue  in  blonde  individuals,  and  brown  or  black  in 
brimettes. 

The  Pupil — The  round 
hole  in  the  centre  of  the  iris  is 
called  the  pupil,  and  is  the 
black  spot  seen  on  looking  into 
a  person's  eye.  This  spot  va- 
ries in  size  according  to  the 
amount  of  light,  being  larger 
in  the  shade  and  smaller  in 
bright  sunshine.  In  human 
beings  it  always  remains 
round,  imless  the  iris  is  dis- 
eased, but  in  the  cat,  for  ex- 
ample, it  changes  its  shape, 
becoming  a  narrow  slit  in  a 
strong  light. 

Use    of    the    Iris This 

closing  up  of  that  curious  cur- 
tain, the  iris,  is  a  beautiful 
provision  for  shutting  oil  an 
excessive  amount  of  light, 
which  would  otherwise  pass  through  the  pupil  in  too  gi-eat  quantity,  and 
irritate  the  sensitive  parts  of  the  organ  of  vision  within. 

The  Sclerotic  Coat — The  sclerotic  coat  is  lined  on  its  inside  with  a 
thin  layer  of  black  membrane,  called  the  clioroid  coat  (3),  which  seems 
to  have  almost  exactly  the  same  object  as  the  black  lining  of  the  photog- 


Section    of    the   Human    Eye. 


STEUCTUEE  OF  THE  EYE.  453 

rajjlier's  camera,  namely,  to  absorb  any  extra  rays  of  light,  and  so  prevent 
tlie  picture  from  being  indistinct. 

Structure  of  Retina. — Inside  of  the  choroid  coat,  and  immediately  in 
contact  with  it,  lies  the  retina,  a  third  hollow  ball,  made  up  of  an  expan- 
sion of  the  optic  nerve,  which  enters  the  eye  at  the  back  (8),  through 
openings  in  the  sclerotic  and  choroid  coats.  The  retina  is  made  up  of 
several  layers,  the  outermost  of  which  is  formed  by  the  terminations  of 
the  nerve-fibres  in  what  are  called  the  rods  and  cones  of  vision.  These 
rods  and  cones  are  so  wonderfully  sensitive  that  through  them  we  can 
perceive  the  differences  of  color  and  outline  in  the  images  of  objects 
formed  within  the  eye.  They  therefore  correspond  to  the  sensitive  plate 
in  the  camera  of  a  photographer. 

Other  Portions  of  the  Eye. — The  remaining  portions  of  the  eye  are 
chiefly  useful  in  forming  this  image  of  which  we  take  cognizance,  and  act 
upon  the  light  exactly  as  the  lenses  of  an  opera-glass  or  of  a  camera  do, 
except  that  they  are  provided  with  a  more  convenient  way  of  changing  the* 
focus  as  may  be  required.  The  first  of  these  which  the  light  reaches,  after 
it  penetrates  the  cornea,  is  the  crystalline  lens  (12). 

Ciystalline  Lens — This  lens  can  be  readily  seen  by  squeezing  it  out 
of  the  eye  of  a  pig  or  sheep  after  death,  is  very  much  like  a  large  dew- 
drop  or  rounded  diamond,  in  size,  shape  and  general  appearance,  and  is 
solid  enough  to  bear  gentle  handling.  It  has  the  form  of  a  small,  thick 
magnifying  glass  or  lens,  and  if  held  over  the  letters  of  a  printed  book,  is 
at  once  seen  to  have  the  same  power  of  making  objects  seen  through  it 
look  larger. 

Position  of  Crystalline  lens. — The  crystalline  lens  is  placed  in  the 
eyeball  a  little  behind  the  iris,  and  is  large  enough  to  extend  out  beyond 
the  edge  of  the  pupil,  unless  that  opening  in  the  curtain  is  wider  than 
usual.  If  it  were  not  so  perfectly  transparent  we  could  see  the  crystalline 
lens  every  time  we  looked  a  person  straight  in  the  eyes,  as  is  shown  in 
cases  of  cataract,  a  disease  where  the  lens  becomes  first  milky  and  then 
opaque,  so  that  its  position  can  easily  be  recognized,  and  the  edge  of  the 
iris  seen  to  move  over  it,  as  the  pupil  expands  and  contracts  under  the 
influence  of  varying  degrees  of  light. 

Arrangement  of  Focus. — Every  one  who  has  looked  much  throiigh  a 
telescope  or  opera  glass,  knows  that  a  different  arrangement  of  focus  ia 
needed  to  show  a  near  and  distant  object  clearly,  and  that  this  altered 
focus  is  obtained  by  adjusting  the  relating  positions  of  the  component 
lenses.     In  the  living  eye,  nature  contrives  to  obtain  this  necessary  effect 


454 


DISEASES   OF   THE   EYE,   EAR  AND   NOSE. 


Flexible   Crystalline   Lena. 


of  t\YO  or  more  leuses  with  a  single  one,  by  making  that  one  (the  crystal- 
line) soft  enough  to  change  its  shape  a  little,  as  shown  in  the  diagram, 
and  then  providing  a  muscle  called  the  ciliary  muscle  (M),  through  the 
action  of  which  the  lens  may  become  more  convex,  that  is,  rounded  (as  at 

B),  and  so  enable  us  to  see 
near     objects     more     dis- 
tinctly.   It  is  the  mecharir 
ical  effort  required  to  keep 
this     little     muscle     con- 
stantly on  the  stretch  that 
causes  the  eyes  to  feel  so 
tired   after   long   applica- 
tion   over    reading    small 
print  or  doing  fine  tcorlc 
of  any  kind.     Hence,  avoidance  of  too  prolonged  a  strain  of  this  nature 
^s  an  important  part  of  the  hygienic  care  of  the  sight,  on  account  of  such 
a  tendency  as  exists  to  exhaust  the  power  of  this  muscle. 

The  Aqueous  Humor — The  space  between  the  crystalline  lens  and  the 
cornea  is  filled  by  the  aqueous  humor  (11),  a  watery  fluid  bathing  the 
front  and  back  of  the  iris,  which,  floating  thus  in  a  clear,  transparent 
fluid,  has  an  opportunity  to  move  with  entire  freedom,  and  so  most  per- 
fectly perform  its  duty  as  a  curtain  to  shut  off  any  excess  of  light  when- 
ever there  is  danger  of  a  superabundance  injuring  the  sensitive  retina 
within.  The  aqueous  humor,  being  shut  in  by  the  convex  cornea,  must, 
of  course,  take  the  shape  of  that  clear  membrane,  and,  forming  with  it  a 
convex  lens,  still  further  aids  the  crystalline  body  in  bringing  the  rays 
of  light  to  a  focus  upon  the  retina,  and  so  forming  a  sharp  image  upon  that 
sensitive  membrane. 

Action  of  Aqueous  Humor. — The  action  of  the  aqueous  humor  in  this 
instance  is  precisely  similar  to  that  of  water  poured  into  a  glass  globe 
standing  in  the  sunshine.  Whilst  the  globe  is  empty,  it  has  but  little  ef- 
fect in  concentrating  the  sun's  rays  into  a  focus,  biit  when  filled  with 
water,  its  power  as  a  lens  is  considerable,  and  it  may  even  operate  so  ener- 
getically as  a  burning-glass  as  to  set  fire  to  inflammable  substances  placed 
at  a  proper  distance.  Want  of  suitable  curvature,  and  also  in  many  cases 
the  fact  of  its  being  curved  unequally  in  different  directions,  by  making 
the  lens  or  magnifying  glass  too  strong  or  too  weak,  has  much  to  do  with 
causing  imperfect  sight. 

Vitreous  Humor The  chief  bulk  of  the  eye  is  made  up  of  the  vitreous 


OPHTHALMIA.  455' 

tumor,  •which  receives  its  name  from  its  vitreous  or  glassy  appearance. 
This  tiuid  is  contained  in  the  cavity  of  the  retina,  and  has  running  through 
it  numerous  fine,  interlacing  fibres,  as  transparent  as  itself,  which  prob- 
ably help  to  prevent  the  delicate  retina  from  being  injured  by  its  shaking 
about  during  violent  movements  of  the  head  and  body. 

Duty  of  Vitreous  Humor — The  vitreous  humor  has  little  or  no  share  in 
aiding  to  form  the  image  upon  the  retina,  but  does  perform  an  important 
duty  in  keeping  the  globe  distended,  so  that  in  a  sound  eye  the  retina  is 
held  at  the  exact  distance,  where  it  can  receive  images  of  objects  cast 
upon  it  in  their  sharpest  and  best  defined  condition. 

ILo-w  to  Understand  the  Eye — -An  excellent  way  to  understand  fully 
how  the  eye  acts  as  an  optical  instrument,  is  to  actually  make  a  camera  of 
the  eye  of  an  ox  or  other  large  animal,  by  cutting  away  the  sclerotic  coat 
at  the  black  part,  and  then  shading  this  in  a  small  box,  for  instance,  so 
that  the  images  formed  by  cornea  and  crystalline  lens  can  be  seen  inverted 
upon  the  translucent  retina  at  the  hinder  portion  of  the  eye. 

Eye  Diseases. — The  diseases  of  the  eye,  according  to  the  nomenclature 
here  followed,  are  seventy-five  in  number,  so  that  it  is  impossible  properly 
to  describe  the  treatment  of  any  but  the  more  important.  Among  the 
first  of  these  are  to  be  ranked  the  diseases  of  the  conjunctiva. 

CONJUNCTIVITIS  OR  OPHTHALMIA. 

Character. — This  is  an  inflammation  of  the  delicate  membrane  over 
the  front  of  the  eye,  covering  the  whole  of  the  cornea,  and  the  part  of  the 
sclerotic  coat  or  white  of  the  eye,  which  is  naturally  visible. 

Symptoms — The  usual  symptoms  of  inflammation  can  nowhere  be 
observed  more  distinctly  than  in  the  eye ;  the  four  great  characters  of  this 
morbid  process,  as  described  by  Celsus,  about  the  beginning  of  the  first 
century,  being  very  apparent.  Here,  as  elsewhere,  redness,  heat,  pain 
and  swelling  are  the  indications  of  inflammation,  just  as  they  were  in  the 
days  of  the  old  Roman  physician,  more  than  eighteen  hundred  years  ago. 
The  redness  of  the  eye  in  this  afEection  varies  with  the  intensity  assumed, 
but  in  severe  cases  it  may  completely  obscure  the  white  of  the  eye,  so  that 
the  whole  surface,  except  the  cornea,  appears  quite  red.  The  pain  and 
burning  heat  of  the  eyes  are  sometimes  almost  unendurable. 

The  Swelling. — The  swelling  of  the  conjunctiva  is  often  so  consider- 
able as  to  rise  up  all  around  the  edge  of  the  cornea,  and  tliis  projection  of 
the  inflamed  membrane  may  be  so  great  as  to  prevent  the  eyelids  from 


456  DISEASES   OF   THE   EYE,    EAE  AND   NOSE. 

being  closed.  Intolerance  of  light  and  profuse  flow  of  tears,  the  latter 
resulting  from  irritation  sympathetically  extended  to  the  lachrjTnal  gland, 
which  supi^lies  those  persuasive  drops  of  salt-water,  are  common  symptoms 
in  some  forms. 

Catarrhal  Conjunctivitis — Catharral-  conjunctivitis  or  catarrhal  oph- 
thalmia, as  it  is  also  named,  is  the  form  of  this  affection  usually  produced 
by  cold.  Redness  and  pain,  as  if  a  particle  of  dust  had  got  into  the  eye, 
with  a  free  discharge  of  water,  are  the  first  symptoms.  Intolerance  of 
light  is  not  very  great,  unless  the  cornea  becomes  involved.  Vision  may 
be  slightly  obscured,  but  is  seldom  seriously  affected. 

Treatment. — 1.  The  treatment  consists  of  active  purgation  with  calo- 
mel (one-tenth  to  one-fifth  of  a  grain  every  hour  until  one  to  two  grains 
are  taken),  followed  by  epsom  or  rochelle  salts.  Soothing  lotions  to  the 
eye,  as,  for  example,  that  of  sassafras  pith  with  a  very  little  extract  of 
belladoima  to  begin  with,  and,  after  a  day  or  two,  applications  of  weak 
solutions  of  lunar  caustic  (silver  nitrate)  should  be  used. 

R. — Silver  nitrate    15  grains 

Distilled  water   I  ounce 

Mix.      Directions. — Apply   to    the    inner   eyelids    with   a 
little  cotton  wrapped  on  a  toothpick  or  a  matchstick. 

The  ap2:)licatiou  should  be  made  once  a  day  for  several  days,  and 
although  the  caustic  solution  smarts  severely  at  first,  it  leaves,  after  fifteen 
or  twenty  minutes,  an  astonishing  feeling  of  relief  to  the  affected  organ, 
and  in  favorable  cases  rapidly  red^ices  the  inflammatory  action. 

2.  To  prevent  the  eyelids  from  adhering  during  sleej),  and  so  aggra- 
vating the  trouble  when  pulled  apart  in  the  morning,  an  ointment  should 
be  used,  preferably  that  recommended  by  Professor  Pegensticker,  which 
is  a  favorite  of  most  physicians.     The  formula  is: 

R. — Yellow  oxide  of  mercury    i  grain 

Vaseline   or  cosmoline    i  ounce 

Mix  thoroughly  and  apply  lightly  to  inner  eyelids  night 
•  and  morning. 

3.  In  many  cases  "ordinary  salt  water  or  a  2  per  cent,  solution 
of  boric  acid  will  suffice  to  effect  a  cure.  Simple  conjunctivitis  of  a 
chronic  nature  is  often  associated  with  catarrh  of  the  nasal  mucous  mem- 
brane, and  may  be  cured  by  correcting  the  catarrh  of  the  membrane." 

Pustular  Ophthalmia — This,  called  also  phlyetsenular  conjunctiritla 


OPHTHALMIA.  457 

and  stramous  oijhthalmia,  is  tbe  form  in  whicli  the  scrofulous  predisposi- 
tion to  disease  is  very  apt  to  manifest  itself  in  young  children.  It  is 
almost  always  accompanied  with  an  eczema  of  the  head  or  face. 

Treatment — In  this  aifection  general  treatment  for  the  constitutional 
disease  is  the  most  important.  .The  patient  should  be  placed  in  the  best 
hygienic  surroundings.  The  eyes  should  be  kept  clean  with  an  antiseptic 
solution,  as  a  2  per  cent,  boric  acid  wash,  and  the  yellow  oxide  of  mercury 
ointment,  mentioned  above,  rubbed  into  the  eyes  once  or  twice  daily. 

Purulent  Ophthalmia — This  is  a  more  violent  and  contagious  form  of 
conjunctivitis,  in  which  the  sight  is  sometimes  seriously  endangered.  The 
discharge  of  thick,  yellow  pus  or  matter  is  abundant,  and  the  inflammation 
sometimes  progresses  with  great  rapidity. 

Treatment — Active  purgation,  leeching  followed  by  blisters  behind 
the  ears,  and  application  of  the  stronger  solutions  of  nitrate  of  silver,  are 
often  necessary  to  preserve  the  sight.  In  the  contagious  variety  great  care 
must  be  taken  to  avoid  conveying  the  disease  from  the  sick  to  the  well  by 
the  use  of  soiled  towels,  handkerchiefs,  and  so  forth. 

Spread  of  the  Infection. — In  bad  cases  it  is  probable  that  the  infection 
may  occur  by  being  wafted  along  in  the  atmosphere  through  a  large  room, 
or  even  through  a  whole  house,  as  is  seen  sometimes  in  boarding  schools 
and  children's  infirmaries. 

Purulent  Ophthalmia  of  Infants  (ophthalmia  neonatorum). — This  is 
another  contagious  form  of  the  disease,  affecting  new-born  children  and, 
if  not  properly  attended  to,  destroying  their  sight.  It  is  the  result  of  an 
infection  with  the  gonocoecus  which  Niesser  discovered  in  1879  to  be  the 
cause  of  gonorrhea.  The  inflammation  develops  in  less  than  three  days 
after  birth. 

Symptoms First  there  is  redness  and  irritability  of  the  conjunctiva. 

2.  In  about  twenty-four  hours  an  excessive  secretion  of  tears  and  a 
whitish  discharge  appears. 

3.  This  is  followed  later  by  a  swelling  of  the  lids  and  of  the  conjunc- 
tiva and  a  change  in  the  character  of  the  discharge  from  a  whitish  to  a 
yellow,  purulent  type. 

4.  The  child  suffers  very  little  at  first,  but  later,  when  the  discharge 
becomes  more  plentiful  and  thinner,  the  patient  loses  his  appetite,  is  rest- 
less and  suffers  a  great  deal  of  pain. 

Treatment The  treatment  is  divided  into  two  classes.     1.   Prophy- 

laetive  or  preventive ;  and  2,  Curative. 

1.  That  prophylaxis  is  possible  was  demonstrated  by  Crede,  a  noted 


458 

obstetrician  of  Bonn,  who  reduced  tlie  percentage  of  these  cases  in  the 
wards  of  his  hospital  frDin  13  per  cent,  to  less  than  2  per  cent. 

Application  of  the  Treatment. — This  he  accomplished  hy  dropping  one 
or  two  drops  of  a  2  per  cent,  solution  of  nitrate  of  silver  in  the  eyes  of 
new-born  infants.  This  procedure  is  commanded  by  law  in  some  com- 
munities. American  authorities  only  recommend  it  where  the  birth  canal 
is  presvimed  or  kno^^^l  to  be  affected. 

Analysis  of  Prophylactic  Treatment — The  Cyclopedia  of  Medicine  and 
Surgery  (Gould  and  Pyle)  says:  The  prophylactic  treatment  consists: 

1.  In  removing  the  disease  from  the  mother  before  labor  if  possible. 

2.  Through  disinfection  of  the  vagina  before  labor  with  solution  of 
creolin,  carbolic  acid,  boric  acid,  salicylic  acid,  mercuric  chloride  or  other 
antiseptic. 

3.  Thorough  disinfection  of  the  child's  eyes  as  soon  as  born. 
These  precautions  should  be  carried  out  in  all  suspicious  cases. 

2.  Curative  Treatment — After  the  disease  has  made  its  appearance, 
the  most  strenuous  efforts  and  the  most  unceasing  vigilance  and  care  are 
demanded  to  prevent  a  partial  or  total  loss  of  sight.  Many  of  the  blind  we 
see  about  us,  for  whom  we  feel  so  much  sympathy,  can  blame  their  un- 
fortunate condition  upon  the  lack  of  treatment  in  the  first  few  days  of 
their  lives. 

If  possible  a  physician  should  be  summoned  at  once  and  his  orders 
followed  implicitly,  and  it  may  be  necessary  for  him  to  see  the  child 
several  times  a  day  to  make  the  necessary  applications. 

Eules  for  Treatment. — If  a  physician  can  not  be  had,  thorough  atten- 
tion to  the  following  rules  will  probably  result  in  a  cure: 

1.  Cold  applications  which  tend  to  lessen  the  amount  of  local  inflam- 
mation. 

2.  Frequent  and  thorough  flushings  of  the  eyes  with  mild  antiseptics, 
as  boric  acid  in  distilled  water  all  day  and  night  every  hoiir  or  two. 

3.  The  application  of  lunar  caustic  (silver  nitrate)  ten  grains  in  the 
fluid  ounce  of  distilled  water,  two  or  three  times  a  day. 

4.  If  any  ulcers  appear  on  the  cornea,  weak  yellow  oxide  of  mercury 
ointment  should  be  rubbed,  thoroughly  but  gently,  into  the  lids  twice  a 
day. 

5.  Xourishment,  cleanliness  and  warmth  must  be  maintained. 
Diphtheritic  Conjunctivitis — This  is  a  condition  of  the  eye  caused  by 

an  infection  with  diphtheria.    Fortunately  it  is  extremely  rare  in  America. 
Symptoms. — Pain  is  present,  the  lids  are  swollen  and  hard.     The  dig- 


DISEASES  OF  THE  COENEA.  459 

charge  is  scanty  and  may  be  watery  or  a  thin  pns.  The  constitutional 
symptoms  of  diphtheria  may  be  present. 

Treatment — Instillations  of  very  weak  solutions  of  atrophine  will  re- 
lieve the  pain.  Antitoxin  should  be  administered  very  early.  Otherwise 
the  treatment  is  the  same  as  in  purulent  conjunctivitis. 

Trachoma — Granular  conjunctivitis,  or  granular  lids,  is  also  a  con- 
tagious disease  of  the  eyes. 

Symptoms — The  inner  sides  of  the  lids  become  rough,  inflamed,  and 
covered  Avith  little  projections  which  irritate  the  cornea  at  every  move- 
ment of  the  ball  or  lids.  It  seriously  affects  vision,  and  is  often  very 
obstinate,  but  can  frecjuently  be  vastly  benefited. 

Treatment. — 1.  Perseverance  in  constitutional  treatment. 

2.  Local  applications  of  nitrate  of  silver  solution,  or  sulphate  of 
copper  to  the  granulations. 

3.  Unless  improvement  follows  soon,  local  treatment  should  be  dis- 
continued and  a  specialist  consulted.     There  is  rarely  complete  recovery. 

DISEASES  OF  THE  CORNEA. 

Causes — Keratitis  or  inflammation  of  the  cornea  may  occur  from  a 
punctured  wound  of  the  eye,  or  it  may  be  the  result  of  the  scrofulous  dia- 
thesis, or  even  more  commonly  of  inherited  syphilis.  It  occasionally 
resiilts  in  ulceration  of  the  cornea,  which  sometimes  perforates  this  struc- 
ture and,  allowing  the  humors  of  the  eye  to  run  out,  irrevocably  destroys 
the  sight. 

Treatment — Local  treatment  of  the  accompanying  conjunctivitis  and 
the  use  of  atropia  to  keep  the  pupil  dilated,  so  that  it,  the  iris,  may  not 
become  involved  in  the  inflammation,  are  important,  but  the  chief  reliance 
must  be  placed  upon  constitutional  remedies  for  those  general  diseases,  of 
which  this  affection  of  the  eye  is  little  more  than  a  symptom.  The  white 
spot  or  scar  left  by  an  ulcer  of  the  cornea  is  generally  permanent,  and  not 
only  disfigures  the  organ  of  vision,  but  more  or  less  completely  obscures 
the  sight  for  life. 

Preventive  Treatment — Since  a  scar  of  this  kind  is  so  injurious  and 
when  once  fully  formed  can  scarcely  ever  be  removed,  the  ounce  of  preven- 
tion is  of  tenfold  importance,  and  every  care  should  be  taken,  by  securing 
the  most  skillful  treatment  for  ophthalmia  as  promptly  as  possible,  to  re- 
duce to  its  smallest  dimensions  the  danger  of  such  a  catastrophe  to  sight. 


460 


DISEASES    OV    THE    EYE,    EAE    AND    NOSE. 


THE  EYE 


Figure    No.     i. — Iris,    ciliary    muscle 
and  coroidca   membrane. 

1.  The  pupil. 

2.  Ciliary  muscle. 

4.  Arteries    of    the    coroidea    mem- 
brane. 
5i5.5.S-  Sclerotic     tunic,     cut     circularly 
and   removed. 

7.  The  optic  nerve. 


Figure    No.     2. — Vertical     section    of 
ihe  pupil. 


Figure  No.  3. — Artificial  eye. 


Figure    No.    4. — External    muscles    of 
pupil. 

I.  Part    of    the    sphenoidal    hone    to 
which    some   muscles   are    at- 
tached. 
2.2.  External   straight   muscle. 

3.  Optic  nerve. 

4.  Internal  straight  muscle. 

5.  Upper  straight  muscle. 

6.  Lower  straight  muscle. 

7.  Upper  oblique  muscle. 

8.  Insertion    of    the    upper    oblique 

muscle  of  the  pupil. 

9.  Lower  oblique  muscle. 

10.  Sclerotic  tunic. 

11.  Cornea. 

.12.  Cartilaginous  pulley  of  the  upper 
oblique  muscle. 

Figure    No.    5. — View    of    the    second 
pair  of  optic  nerves. 


1.  Globe  of  the  eye.     The  left,  per- 

fect. The  right  one  has  the 
sclerotic  and  coroidea  tunics 
removed,   sliovving  the   retina. 

2.  Quiasm  of  the  optic  nerve. 

3.  The  whitish  bodies. 

4.  The  infundible. 

5.  Varolius  bridge. 

6.  The  medulla  oblongata. 

7.  Third  pair:    motor  nerves  of  the 

eye. 

8.  Fourth  pair  :    pathetic. 

9.  Fifth  pair:    trigcminous. 

10.  Si.xth   pair :     external   motors. 

11.  Seventh  pair:    auditive  and  facial 

nerves. 

12.  Eighth    pair :  pneumogastric,  ac- 

cessory, spinal  and  glosso- 
pharyngeal. 

13.  Ninth  pair :    hypoglossus. 

Figure  No.  6. — Lachrymal  apparatus 
(the  skin  of  the  eyelid  has  been  re- 
moved). 

1.  Cartilage  of  the  eyelid. 

2.  Insertion  of  the  eyelashes. 

3,3.  Lachrymal  ends  or  openings  of 
lachrymal  canals  in  the  eye- 
lids. 

4.  Conduit  to  the  nose. 

6.  Cul-de-sac  at  the  orbital  extrem- 

ity of  the  canal. 

7.  Lower  corner  of  the  eye. 
9.  Lachrymal  gland. 

10,10.  Canals  carrying  tears  to  the  eye. 


Figure     No.     7. — Formation     o*     an. 
image  on  the  retina. 


Fia.  1. — The  iris,  the  ciliary  muscle  and 
coroiilea  ineiiil»raiie. 


Fia.  3. — An  artificial  eye. 


FiQ.  2. — Vertical  section  of  the  pupil. 


Fin.  4. — Exfernnl  niusoles  of  the  puj>il. 


F'Q.  5. — View  of  tlic  6f<'nml    pair  of 
optic  nerves. 


Fig.  6. — Lachrymal  :ip]>aralus   (eyelid  skia 
has  been  removed). 


Fio.  7. — Kdrnialion  of  an  imatre  in  the  retina 


THE  EVE. 

For  an  explanation  of  the  illustrations  see  text  on  opposite  page.  46J 


462  DISEASES   OF   THE   EYE,    EAE   AND   NOSE. 

DISEASES  OF  THE  SCLEHOTIC  COAT. 

Symptoms — Inflammation  of  the  sclerotic  coat,  or  sclerotitis,  is  gen- 
erally characterized  bv  the  intense,  deep-seated  pain  it  causes,  and  by  the 
pink  hue  of  the  white  of  the  eye  produced.  The  chief  varieties  are  the 
rheumatic  and  the  syphilitic. 

Treatment. — The  treatment  is  to  be  more  especially  directed  towards 
counteracting  by  general  remedies  the  poisons  of  these  two  virulent  con- 
stitutional affections. 

miTTS. 

Character. — This  is  an  inflammation  of  the  iris,  which  may  be  simple 
or  gouty,  syphilitic  or  scrofulous. 

Symptoms — Its  symptoms  are  intense  pain  in  most  cases,  although  in 
others  little  uneasiness  is  felt ;  change  in  color  of  the  iris,  contraction  of  the 
pjupil,  and  impairment  of  vision.  Inflammation  of  the  iris  has  always  pos- 
sessed a  great  interest  for  physicians,  because  it  is  the  only  cavity  lined  by 
a  serous  membrane  into  which  we  have  the  privilege  of  looking  and  seeing 
what  is  going  on  when  the  membrane  which  forms  its  boundary  is  in- 
flamed. Hence,  the  observation  of  a  case  of  iritis  is  not  only  the  most 
interesting,  but  also  the  most  instructive,  lesson  in  the  sciences  of  path- 
ology and  therapeutics  which  nature  ever  vouchsafes  to  us,  as  we  carefully 
watch  the  progress  of  the  disease  and  the  effects  of  medical  treatment  from 
day  to  day. 

Treatment. — Since  one  of  the  greatest  dangers  of  iritis  is  that  the 
pupil  will  be  drawn  together  by  the  whitish  lymph  infused  in  the  inflam- 
matory process,  and,  by  being  thus  closed,  shut  off  the  sight,  it  is  vei'v 
important  to  keep  this  opening  of  the  pupil  as  large  as  possible  by  the  use 
of  belladonna,  or  its  active  principle,  atropia,  throughout  the  attack  of 
iritis.  Besides  this,  general  bleeding,  or  free  leeching  behind  the  ears, 
or  on  the  nape  of  the  neck,  followed  by  repeated  blistering,  should  be  em- 
ployed, and  active  purgatives  with  merciiry  to  slight  salivation  contribute 
toward  the  cure.  Opium  by  hypodermic  injection  to  relieve  the  intense 
pain,  and  cool  anodyne  applications  to  the  affected  organ,  are  valuable 
palliatives. 

RETINITIS. 

Character. — This  is  an  inflammation  of  the  retina  and  seldom  occurs 
alone.  It  may  be  due  to  Bright's  disease,  may  result  from  a  specific  taint, 
or  may  be  of  the  hemorrhagic  variety.    The  last  named  condition  is  nearly 


OATAEAOT.  463 

always  in  the  aged  and  is  an  occasional  accident  happening  in  cases  where 
the  kidneys  are  hard  and  shnmken. 

Treatment. — The  treatment  is  of  course  directed  to  the  disease  which 
causes  this  inflammation. 

CHOROIDITIS, 

Causes. — This  is  also  usually  in  conjunction  with  systemic  diseases,  as 
tuberculosis,  syphilis,  rheumatism  and  gout.  The  suppurative  variety  may 
be  due  to  a  blow  or  may  be  carried  from  some  distant  suppurative  process. 

Treatment. — The  treatment  is  directed  to  the  cause  and  is  mostly 
general. 

AMAUROSIS  OR  GUTTA  SERONA. 

Character — This  is  a  disease  of  the  retina,  dependent  upon  various 
changes  of  the  retinal  surface  and  ending  in  an  inability  of  the  nervoua 
expansion  to  receive  and  transmit  visual  impressions  from  the  outside 
world  to  the  brain. 

Causes. — 1.  It  may  be  produced  by  exposure  of  the  eye  for  a  longer 
or  shorter  period  to  a  white,  dazzling  object  like  snow,  and  snow-blindnes3 
is  the  most  familiar  example  of  this  affection. 

2.  It  also  occurs  occasionally  from  accidents,  such  as  lightning-stroke 
and  blows  on  the  head. 

3.  It  may  be  due  to  degenerative  changes  in  the  retina  following 
exhausting  illness,  or  connected  with  sympathetic  irritation. 

4.  Excessive  use  of  tobacco  sometimes  produces  it. 

Treatment — ^^Vhere  the  cause  of  amaurosis  can  be  discovered  and 
removed,  some  hope  of  cure  may  be  indidged,  but  ordinarily  the  melan- 
choly fate  of  becoming  permanently  blind — as  the  poet  Milton  was  ren- 
dered by  this  malady — awaits  the  patient.  Of  course,  the  earlier  treat- 
ment is  imdertaken  the  better  is  the  chance  of  arresting  the  malady  before 
utter  destruction  of  the  sight  is  accomplished. 


CATARACT. 

Character. — This  is  an  inappropriate  but  long-established  term  indi- 
cating an  opacity  of  the  crystalline  lens  of  the  eye.  In  cataract,  the  lens 
becomes  white  and  opaque,  first  at  some  point  on  its  surface,  or  in  the 
capsular  membrane  which  envelops  the  albumenoid  substance  of  whicli 


4G1: 


DISEASES    OF    THE    EYE,    EAR    AND    NOSE. 


the  lens  is  composed.     The  opacity  extends,  until  at  length  the  whole  of 
the  lens  may  be  involved,  and  blindness  rendered  complete. 

Development  of  Cataract — The  development  of  cataract  is  usually 
slow  in  its  progress,  except  in  the  case  of  diabetic  cataract,  or  cataract 
from  a  pimctured  wound,  which  may  form  in  a  few  days.  The  process 
of  becoming  totally  opaque  is  called  by  surgeons  the  ripening  of  the 
cataract,  and  it  is  customary  to  wait  for  the  cataractous  change  or  ripen- 
ing to  he  complete  before  any.  operation  is  attempted  for  its  cure. 

Causes — Most  frequently  there  is  some  change  in  the  vascular  system 
supplying  the  lens,  and  to  this  lack  of  nutrition  is  due.  Senility,  diabetes 
niellitus,  convulsions,  injury,  exposure  and  privation  are  the  causes. 

Treatment — No  medical  treatment,  as  yet  discovered,  is  of  any  avail 

in  the  treatment  of  cataract,  but 
the  disease  may  be  entirely 
remedied  by  the  operation  of  ex- 
traction, which  is  illustrated  in  the 
accompanying  figure.  As  there 
shown,  a  peculiar,  wedge-shaped 
knife,  called  a  cataract-knife,  is 
used  to  cut  an  opening  in  the  edge 
of  the  cornea,  through  which  the 
opaque  lens  is  carefully  drawn  out,  and  then  the  eye  closed  lip  and  per- 
mitted to  heal. 

Restoration  of  Vision. — When  successful,  as  this  operation  proves  in 
the  hands  of  skillful  oculists  nearly  nine  times  out  of  ten,  useful  vision 
is  restored,  and  by  the  aid  of  very  thick  spectacles,  to  substitute  the  lost 
crystalline  lens,  the  patient  is  often  enabled  to  read,  write  or  sew,  as  well 
as  before  being  attacked  with  this  disease.  This  operation  of  extracting 
the  cataract  is  generally  the  most  successful  with  the  common  form,  which 
occurs  in  old  people,  where  the  crystalline  lens  is  not  only  opaque,  but 
hardened  into  a  sort  of  horny  substance. 

Treatment  of  Other  Forms — In  some  of  the  other  varieties  of  cataract, 
such  as  that  produced  by  wounds  or  other  injuries,  especially  in  young 
people,  the  treatment  by  breaking  up  the  lens  with  a  very  delicate  knife, 
about  the  size  of  a  large  needle,  is  resorted  to  with  success.  The  old- 
fashioned  operation  for  cataract  by  couching,  or  reclination  of  the  opaque 
crystalline  lens,  is  now  generally  abandoned,  as  being  much  less  satisfac- 
tory in  every  way  than  the  process  of  extraction. 

Cataract  Often  Hereditary — The  tendency  to  the  formation  of  cataract 


Operation    for    Cataract. 


WEAK  SIGUT.  465 

is  often  hereditary,  but  something  can  be  done  by  hygienic  care  of  the 
eyes  to  avert,  or  at  least  to  postpone,  its  active  development.  Since  it  has 
been  found  that  operatives  who  use  their  eyes  opposite  to  a  very  strong 
light — such  as  glass-blowers — are  particularly  liable  to  cataract,  it  is 
advisable  to  avoid  such  exposure  as  much  as  possible. 

Effect  of  Electric  Lights.^ — Very  probably  electric  lights  may  tend  to 
ju'omote  the  formation  of  cataract,  unless  guarded  with  special  care.  It 
is  a  curious  fact,  however,  and  one  which  at  once  disproves  the  fanciful 
theory  that  cataract  is  a  disease  of  over-civilization  and  excessive  study, 
that  cataracts  are  frequently  met  with  in  animals,  especially  the  horse, 
where  the  disease  may  often  be  seen  in  great  perfection. 

GIATJCOMA. 

Symptoms.— This  is  a  disease  in  which  tte  most  prominent  symptom 
is  an  increase  in  the  tension  of  the  eyeball.  By  primary  glaucoma  we 
mean  an  increase  in  tension  originating  in  the  eye  itself  independent  of 
any  outside  influence.  Secondary  glaucoma  is  the  same  condition  due  to 
an  injury,  some  previous  inflammatory  process,  or  resulting  from  valvular 
heart  disease,  and  so  forth. 

If  the  glaucoma  is  simple  in  character,  the  first  symptom  is  partial 
loss  of  vision.  In  cases  of  inflammatory  character  pain  may  be  the  first 
feature  to  attract  attention  and  may  be  much  more  severe  at  times. 

Predisposing  factors  are  heredity,  excesses  of  various  kinds,  gouty 
or  rheumatic  tendencies. 

Treatment — Medical  treatment  is  of  value  in  some  primary  cases. 
Warm  applications  may  ease  the  pain,  or  instillation  of  one-quarter  to  one 
per  cent,  solution  of  eserine.  Operative  measures  of  various  kinds  may 
be  necessary  from  iridectomy  to  complete  removal  of  the  globe. 

WEAK  SIGHT  OR  ASTHENOPIA. 

Weak  or  enfeebled  sight,  though  a  term  in  familiar  use,  is  not  easily 
defined  as  specially  connected  with  any  constant  change  in  the  eyeball. 

Causes — It  may  be  due  to  an  irritable  condition  of  the  retina,  or  to 
an  impoverished  state  of  the  blood.  More  frequently,  perhaps,  it  arises 
from  a  want  of  power  to  keep  up  the  accommodation  of  the  eye  for  dis- 
tances, to  nervous  anxiety  about  the  sight,  or  to  the  commencement  of  one 
of  the  serious  organic  diseases  about  the  eyes  and  its  appendages. 

Treatment. — Except  in  the  latter  case,  much  can  be  done  by  treat- 
30 


466  DISEASES   OF   THE   EYEj    EAB   AND   NOSE. 

ment,  using  general  and  local  tonics,  and  by  care  of  the  eyes  in  the  modo 
to  be  pointed  out  in  the  next  article. 

SHORT-SIGHT  OR  MYOPIA. 

Character. — This  is  a  very  common  condition  of  vision  in  which,  from 
the  greater  convexity  or  improper  position  of  the  lenses  of  the  eyeball, 
the  focus  of  parallel  rays  of  light  does  not  fall  upon  the  retina,  but  at  some 
point  in  the  vitreous  humor.  This  error  of  development,  as  it  often  is, 
•will  be  better  comprehended  by  the  aid  of  the  annexed  figure,  in  which 
is  shown  a  diagram  of  the  eyeball  and  the  course  of  the  rays  of  light,  to 
form  a  clear  and  distinct  image  of  the  arrow,  on  the  retina  at  h,  h.  If, 
however,  the  eyeball  is  elongated,  so  that  the  retina  occupies  the  position 
of  the  line  marked  3,  as  is  often  found  to  be  the  case  in  near-sighted  per- 
sons, it  is  obvious  that  the  rays  of  light  will  have  passed  their  true  focus, 


The  Error  In   Curvature   of  Lena. 


and  consequently  when  they  reach  the  retina  in  this  wrong  position  can 
only  give  a  blurred  and  indistinct  image  of  the  object. 

Remedy. — The  remedy  for  myopia  is  the  use  of  a  concave  glass,  ac- 
curately adapted  to  the  particular  eye  for  which  it  is  employed,  and 
just  strong  enough  to  render  the  rays  of  light  so  divergent  when  they 
strike  the  cornea  that  they  will  be  brought  to  an  exact  focus  upon  the 
misplaced  retina,  in  its  unnatural  position,  making  in  this  way  one  error 
precisely  coimterbalance  the  other. 

Application  of  the  Remedy — This  remedy  should  by  all  means  be 
applied  even  in  early  youth,  in  order  to  prevent  the  effort  of  accommoda- 
tion, the  straining  of  the  eye  to  see  as  much  as  other  children  do  at  school 
and  elsewhere,  from  not  only  increasing  the  myopia,  but  laying  the 
foundation  of  more  serious  disease  and  ultimately,  perhaps,  destroying 
the  sight. 

Increase  of  Short-Sightedness. — The  alarming  increase  of  myopia,  and 


SHORT  SIGHT.  467 

especially  Its  prevalence  among  young  people  of  both  sexes  in  city  schools, 
must  have  caused  many  observant  biologists  to  speculate  as  to  the  exact 
mechanism  by  which  the  imfavorable  influences  of  our  present  civilization 
■were  at  work  so  as  to  bring  about  this  rapid  deterioration  of  the  visual 
organs  in  the  last  few  generations  of  mankind. 

Myopia  Hereditary — There  is  no  doubt  also  that  myopia  is  hereditary, 
and  that  according  to  the  great  law  of  '"the  extinction  of  the  unfit,"  the 
children  of  myopic  parents  are  pi'cdisposed  to  the  development  of  this 
disease.  Hence  they  will  almost  certainly  suffer  from  it  if  they  are 
exposed  to  conditions  which  would  be  apt  to  engender  near-sightedness 
in  healthy  eyes,  from  any  taint  of  hereditary  tendency. 

Preventive  Measures — Among  the  general  conclusions  arrived  at  by 
scientists  for  aiding  in  this  object,  so  important  to  the  rising  generation, 
the  following  are  worthy  of  especial  notice : 

1.  In  the  iirst  place,  study-rooms  should  be  well  lighted  during  the 
day,  and  especially  toward  evening,  because  a  feeble  or  badly-arranged 
light  compels  us  to  diminish  the  distance  between  the  eye  and  the  book 
whilst  reading  or  writing. 

2.  Light  should  be  allowed  to  enter  from  the  left  side.  Illumination 
from  the  front  is  more  or  less  dazzling,  and  obliges  the  pupils  to  bend 
forward  too  much,  or  to  sit  sidewise  in  constrained  and  fatiguing  positions. 
Again,  light  coming  from  behind  is  entirely  insufScient,  because  in  great 
measure  cut  off  by  the  head  and  upper  part  of  the  body  of  each  scholar. 

3.  The  windows  of  a  school-room  should  be  large  and  high,  'and  be 
arranged  along  the  left  side  of  the  apartment,  so  as  to  shed  the  light  upon 
desks  placed  in  rows,  at  right  angles  to  the  wall  in  which  the  windows 
are  cut. 

4.  The  light  from  above,  furnished  by  a  skylight,  is  not  so  good  as 
that  derived  from  lateral  illumination.  The  light  of  lamps  is  recom- 
mended as  being  preferable  to  gas,  and  the  gaslight  shining  through 
ground-glass  globes  is  condemned  as  being  particularly  objectionable. 

6.  The  inclination  of  the  desk  at  which  the  pi:pil  sits  to  read  or  write 
Is  a  matter  of  no  small  importance.  Desks  which  are  horizontal,  or  only 
slightly  inclined,  favor  the  development  of  myopia,  by  compelling  thte 
scholar  to  bend  the  head  over  a  good  deal  whilst  reading  or  writing.  Such 
a  position  brings  on,  as  a  result  of  mere  weight  of  the  blood,  passive  con- 
gestion of  the  head  and  eyes,  and  this  in  turn  results  In  an  Intra-ocular 
tension,  insensible,  perhaps,  when  it  first  appears,  but  very  marked  in  its 
effects  when  long  and  constantly  continued. 


468  DISEASES   OF   THE   EYE,   EAE  AND    NOSE. 

Children's  School  Desks — Besides,  a  child  who  acquires  the  habit  of 
leaning  forward  in  this  manner  is  very  apt  to  bend  nearer  and  nearer  his 
book,  as  the  muscles  of  his  back  become  fatigued,  and  thus,  by  straining 
his  power  of  accommodation  at  short  focus,  promote  the  rapid  development 
of  myopia.  The  desks  of  school  children  should  therefore  be  sharply  in- 
clined at  an  angle  of  -iO  degrees  or  45  degrees  when  used  for  reading,  and 
their  seats  should  not  be  too  high,  and  should  be  furnished  with  comfort- 
able backs. 

6.  Great  care  should  be  taken  to  secure  school-books  well  printed  in 
large,  clear  type ;  since  those  printed  in  small,  indistinct  letters,  upon  bad 
paper,  with  poor  ink,  as  is  the  case  with  too  many  of  the  classics  and  the 
dictionaries  in  common  use,  necessitate  a  close  approximation  of  the  eyes 
to  the  page,  and  consequently  exaggerated  efforts  at  accommodation,  favor- 
ing myopia.  Furthermore,  all  punishments  of  school  children  which  con- 
sist in  depriving  them  of  recreation  or  exercise  out  of  duors,  or  in  adding 
to  their  amount  of  study,  and  consequent  employment  of  the  visual  ai> 
paratus,  should  be  relin(pnslic'd. 

Faults  of  School  Furniture. — The  general  principles  which  must  be 
kept  in  view  in  the  construction  of  seats  and  desks  for  school  children, 
according  to  the  investigation  of  Cohn  and  others,  may  be  expressed  as 
follows : 

The  faults  of  school  furniture  which  give  rise  to  injurious  postures, 
and  so  conduce  both  to  myopia  and  asthenopia,  as  well  as  to  scoliosis  or 
lateral  curvature  of  the  spine,  are: 

1.  Want  of,  or  unsuitable,  backs. 

2.  Too  great  a  distance  between  the  seat  and  the  desk. 

3.  Disproportion,  generally  too  gi-eat  a  difference  between  the  height 
of  the  seat  and  that  of  the  desk. 

4.  Wrong  form  and  slope  of  the  desk. 

Ideal  School  Desks. — Dr.  Liebreich  gives  a  very  clear  exposition  of 
the  way  in  which  these  defects  cause  the  diseases  already  mentioned,  ami 
concludes  with  the  subjoined  recommendations,  which  he  considers,  how- 
ever, less  advantageous  than  what  he  calls  the  American  jDlan  of  having 
the  seat  and  desk  made  to  every  child's'  measure,  or  the  Swiss  system, 
where  seven  or  more  different  sizes  of  seats  and  desks  are  manufactured 
to  suit  the  different  classes: 

1.  One  and  the  same  size  and  model  desk  should  be  used  for  chil- 
dren and  grown-up  persons  of  both  sexes. 


ASTIGMATISM.  469 

2.  The  adaptation  to  the  height  of  each  child  should  he  effected  hj 
varying  the  height  of  the  seat  and  the  footboard. 

3.  The  edge  of  the  table  is  always  to  be  in  a  perpendicular  line  above 
that  of  the  seat. 

4.  ^0  seat  is  to  be  without  a  back,  and  the  top  of  this  is  always  to  bo 
one  inch  lower  than  the  edge  of  the  table  for  boys,  and  one  inch  higher 
than  the  edge  of  the  table  for  girls. 

5.  In  all  classes  where  the  boys  change  places  the  height  of  the 
seat  is  to  be  regulated  in  proportion  to  the  average  height  of  the  pupils. 

6.  In  all  girls'  schools,  in  all  those  boys'  schools  where  the  children 
do  not  change  places,  in  boarding  schools,  and  in  private  schoolrooms, 
the  seat  of  each  child  should  be  accurately  regulated  in  proportion  to  its 
height. 

Back  Support,  Etc — The  support  for  the  back  should  incline  only  a 
few  degrees  from  the  perpendicular,  and  be  so  arranged  as  to  press  upon 
the  spinal  column  jiist  above  the  hips  of  the  pupil.  The  breadth  of  the 
seat  should  be  considerable,  in  order  to  support  most  of  the  thighs,  and  its 
height  just  such  as  to  allow  the  feet  to  rest  easily  upon  the  footboard. 
The  desk  should  be  so  arranged,  by  means  of  a  hinged  flap  or  otherwise, 
as  to  hold  the  book  at  an  angle  of  40  degrees  or  45  degrees  whilst  reading, 
and  ihe  paper  at  an  angle  of  20  degrees  whilst  writing  is  being  performed 
by  the  scholars. 

ASTIGMATISM. 

Definition — This  term  is  applied  to  a  defect  of  sight  due  to  a  differ- 
ence in  the  curves  of  the  cornea  and  crystalline  lens  in  different  directions ; 
that  is  to  say,  the  cornea,  for  example,  may  be  so  cui'ved  in  the  direction 
of  a  horizontal  line  through  it  as  to  have  a  focus  of  one  inch,  and  be  so 
much  less  curved  on  a  perpendicular  line  that  its  focus  in  that  direction 
is  an  inch  and  a  quarter.  The  result  of  this  different  refraction,  in 
different  meridians  of  the  globe  of  the  eye,  is  necessarily  an  indistinctness 
of  vision,  because  all  the  rays  of  light  entering  the  eye  from  a  bright  point 
are  not  brought  precisely  to  a  point  again  upon  the  retina  as  they  should  be. 

Treatment — This  defect,  which  is  found  to  be  exceedingly  common, 
especially  in  myopic  eyes,  can  be  very  accurately  corrected  by  the  use 
of  properly  adjusted  cylindrical  glasses,  which  are  so  arranged  as  to  distort 
the  rays  of  light  before  they  enter  the  eye  just  enough  in  a  contrary 
direction  to  cause  them  to  be  brought  to  an  exact  focus  by  the  imperfect 
cornea  and  crystalline  lens  of  the  astigmatic  eye. 


'470  DISEASES   OF   THE   EYE,   EAK   AND   NOSE. 

Use  of  Spectacles. — Spectacles  giving  this  compensation  ought  to  be 
procured  and  faitlifuUj  worn,  not  only  because  their  use  will  tend  to  pre- 
serve the  e^'es,  which  would  otherwise  be  apt  to  grow  strained  in  the  effort 
to  niaie  up  for  this  defect  by  accommodating  the  lens,  but  also  on  account 
of  the  headache  which  is  often  the  result  of  such  constant  effort  to  adapt 
the  eye  to  clearer  vision. 

Day-Blindness — Day-blindness  is  a  term  used  to  describe  a  disease  in 
which  the  person  affected  can  only  see  when  the  light  is  subdued,  as  in 
the  twilight. 

Night-Blindness. — !Night-blindness,  on  the  contrary,  indicates  a  con- 
dition in  which  there  is  indistinctness  of  vision,  except  in  a  bright  light. 

Causes. — The  causes  of  these  two  conditions  are  not  very  well  under- 
stood, but  night-blindness  is  known  to  chiefly  affect  those  who  have  used 
their  eyes  too  long  and  too  steadily  in  a  brilliant  illumination  or  who  have 
been  exposed  to  intense  or  sparkling  light. 

Treatment. — liest  is  the  chief  means  of  cure,  but  prevention  of  these 
diseases  by  the  proper  protection  of  the  organs  of  vision  by  colored  glasses, 
or  by  the  mechanical  apijliances  mentioned  when  speaking  of  light,  is  in- 
finitely preferable. 

DISEASES  OF  THE  TEAR  APPARATUS. 

Characxer. — The  lachrymal  gland,  which  suj^plies  the  tears,  and  is 
situated  at  the  upper  and  outer  angle  of  the  eye,  is  subject  to  inflamma- 
tion and  the  usual  structural  changes  which  result  from  that  process.  The 
most  common  disease,  however,  connected  with  the  lachrymal  apparatus 
is  obstruction  of  the  lachrymal  duct  or  tube,  which  runs  from  the  inner 
corners  of  the  eyelids  down  into  the  cavity  of  the  nose,  and  conveys  the 
.tears  into  the  nasal  cavity,  which,  under  ordinary  circumstances,  they 
merely  serve  to  keep  comfortably  moist. 

Causes — This  obstruction  may  result  from  inflammation  of  the  lining 
membrane  of  the  duct,  caused,  perhaps,  by  cold  or  brought  about  by  acute 
or  chronic  inflammations  of  the  nasal  chambers.  If  neglected,  abscess 
may  result  requiring  surgical  interference. 

Treatment. — In  its  incipiency  attention  to  the  nasal  passages  and 
correction  of  the  deformities  and  catarrhal  condition  there  may  suffice 
to  effect  a  cure  of  the  constriction  of  the  duct.  While  acutely  inflamed, 
anodyne  lotions,  as  lead  water  and  laudanum,  cold  or  hot  applications 
should  be  faithfully  tried.  When  dilatation  of  the  duct  is  demanded  it 
shotild  be  continued  until  a  cure  is  effected. 


DISEASES   OF   THE   EYELIDS  471 

DISEASES  OF  THE  EYELIDS 

STYE  OR  HOEDEOLTJM. 

A  stye  is  a  little  boil  at  tke  edge  of  the  lid. 

Causes. — When  styes  recur,  refractive  errors  should  be  at  once  sus- 
pected and  corrected.  Ill  health  favors  a  stye  as  it  does  boils  in  other 
localities.     Uncleanliness  is  sometimes  the  cause. 

Symptoms — These  are  so  well  known  that  it  is  not  necessary  to  go 
into  them.  Suffice  it  to  say  that  when  a  yellow  spot  is  discernible  on  the 
stye,  it  is  ripe  and  should  be  opened. 

Treatment — To  hasten  the  pointing  of  a  stye,  apply  hot  compresses 
for  fifteen  minutes  every  two  hours.  Tonics  are  indicated  in  the  debili- 
tated ;  glasses — properly  fitted — should  be  worn,  and  a  boric  acid  eyewash 
used  until  long  after  the  stye  has  disappeared. 

whd  hairs  or  trichiasis. 

Dangers. — This  is  the  name  for  that  growing  in  of  the  eyelashes,  com- 
monly known  as  wild  hairs  in  the  eye.  Even  one  of  these  hairs,  by  rub- 
bing upon  the  sensitive  cornea  whenever  the  patient  winks,  may  cause 
much  irritation  and  even  injury  to  the  sight. 

Treatment. — Temporary  relief  is  afforded  by  pulling  out  the  offend- 
ing hairs  with  small  tweezers,  but  often  a  surgical  operation  is  necessary 
to  accomplish  a  permanent  cure. 

SQUINTING  OR  STRABISMUS. 

Character. — This  disease  is  the  commonest  of  the  derangements  of 
the  eyeballs  within  their  orbits.  In  it  the  eye  is  involuntarily  drawn  from 
its  straight  position  to  one  or  the  other  side,  so  that  the  natural  and  agree- 
able parallelism  of  its  axis  with  that  of  its  fellow  is  not  maintained. 
When  the  eyes  are  turned  in  toward  the  nose,  as  is  more  commonly  the 
case,  the  strabismus  is  called  convergent,  and  when  the  squint  is  outward, 
it  is  spoken  of  as  divergent  strabismus. 

Causes — This  defect  is  due  either  to  shortening  of  one  of  the  six 
little  muscles  by  which  the  eyes  are  moved  in  their  sockets,  or  to  the 
spasmodic  contraction  of  one  of  these  muscles,  or  to  paralysis  of  one  of 
them  and  relative  over-action  of  its  natural  opponent.     Strabismus  is  in 


472  DISEASES  OF  THE  EYE,   EAE  AND  NOSE. 

some  eases  an  acquired  affection,  and  may  even  resnlt  from  the  bad  habit 
among  children  of  imitating  deformities  of  this  kind.  More  frequently 
it  appears  to  be  the  product  of  hereditary  tendency.  It  may  affect  both 
eyes  in  the  same  person,  and  even  in  the  same  direction,  and  is  then 
called  double  strabismus,  or  it  may  be  confined  to  one  eye,  the  other 
remaining  j^erfectly  healthy. 

Treatment. — Something  can  be  done  in  the  treatment  of  this  malady 
when  it  first  commences  in  children  who  are  not  too  young  to  wear  spec- 
tacles by  having  these  arranged  with  half  pieces  of  black  glass,  so  that 
the  patient  is  compelled  to  look  straight  forward.  But  the  simple  opera- 
tion of  cutting  through  a  part  or  the  whole  of  the  contracted  muscle  is  in 
suitable  cases  the  best  remedy,  and  often,  not  always,  proves  perfectly 
successful  in  removing  the  deformity. 

TRACHOMA   (Granulated  Eyelids). 

Trachoma  is  a  highly  contagious  disease  which  attacks  the  eyes.  It 
is  a  granular  conjunctivitis,  characterized  by  small,  sago-like  elevations  on 
the  conjunctiva,  followed  by  the  lids  adhering  to  the  eyeball,  ulcers  form 
and  the  eyelids  contract  and  are  deformed,  at  the  same  time  destroying 
the  sight. 

Persons  of  all  ages  suffer  from  this  disease  and  school  children  are 
exposed  to  it  in  the  moimtainous  districts  of  Kentucky  and  other  States  in 
the  United  States. 

The  disease  is  spread  by  the  ignorant  persons  of  pauper  countries, 
where  their  habits  are  dirty.  They  usually  know  nothing  of  sanitation 
or  hygiene.  They  live  in  large  numbers  in  small  huts  or  cabins,  which 
are  scarcely  large  enough  for  two  people;  all  using  the  same  towel  and 
sleeping  in  the  same  bed  with  the  one  who  suffers  from  the  disease. 

Prevention — A  child  or  adiilt  suffering  from  trachoma  must  be  iso- 
lated from  the  rest  of  the  family,  school  children,  etc.  As  these  cases 
occur  among  the  very  poor  they  should  receive  treatment  in  a  public  in- 
stitution. The  State  and  Federal  authorities  can  prevent  its  spread  by 
appropriating  money  to  fight  the  disease,  by  sending  into  the  mountainous 
districts,  physicians  and  nurses  to  treat  and  educate  the  people;  erect  suit- 
able buildings  to  place  the  sufferers  in  until  cured. 

Every  person  with  granulated  eyelids  or  sore  eyes  should  summon  a 
physician,  or  report  the  trouble  to  the  local  board  of  health,  as  immediate 
attention  to  the  trouble  will  prevent  blindness  and  protect  others.    No  case 


DISEASES  OF   THE  EAE. 


473 


should  be  treated  by  home  remedies.  Delay  means  blindness  to  you  and 
others  in  the  com.muniti/. 

Do  not  use  a  towel  that  any  one  else  uses  if  you  have  granulated  lids. 
Do  not  go  near  any  public  place  where  people  congregate.  Do  not  use  the 
family  linen,  etc. 

Blindness  spreads  through  ignorance  of  the  individual,  the  State's 
and  the  National  Government's  indifference  to  the  dangers  of  gonorrhoea 
and  trachoma  by  not  appropriating  funds  to  fight  them.  The  negligence 
of  the  sufferer  from  gonorrhoea,  his  shame  and  lack  of  treatment  are  rea- 
sons for  blindness. 

Educate  your  children  in  the  danger  of  these  diseases,  watch  their 
morals  and  have  them  treated  when  contaminated.  Be  free  from  disease 
before  marriage. 


DISEASES  OF  THE  EAR. 

Number  of  Diseases. — The  number  of  diseases  of  the  ear  is  twenty- 
foiir,  but  as  a  majority  of  them  require  for  their  recognition  and  effective 
treatment  more  or  less  peculiar  and  costly  apjiaratus,  only  a  few  of  the 
most  important  require  notice  in  this  chapter.     For  the  imderstanding  of 

these,  however,  a  brief  re- 
view of  the  anatomy  of  the 
ear  is  necessary. 

Anatomy  of  the  Ear 

The  external  ear,  or  auricle, 
as  anatomists  call  it,  is  sup- 
I^osed  by  many  people  to  be 
the  chief  part  of  the  organ 
of  hearing,  but  in  reality 
the  essential  pieces  lie  in- 
side the  head,  some,  indeed, 
imbeddod  in  the  most  solid 
bone  of  the  skull,  and  one 
so  hard  that  it  has  received 
the  name  of  the  petrous  or 
rocky  portion  of  the  tem- 
poral bone. 

Auditory  Canal — Besides  the  auricle,  which  is  all  that  portion  of  the 
ear  projecting  from  the  head,  the  external  ear  is  considered  by  anatomists 


Section  of  Right  Ear. 


474 


DISEASES   OF    THE    EYE,    EAE   AND    NOSE. 


THE  EAR  AND  ORGANS  OF  HEARING 


Figure  No.  i. 
I,  2,  3.  The    inner    cavity    open,    show- 
ing the  spiral  lamina. 
4,  5,  6.  Rest  of  the  cells  of  the  inner 
cavity. 
7,  8.  Vestibule. 
9,  10.  Upper  canal. 
II,  12.  Lower  canal. 
13.  Outer  canal. 
14,  14.  Semicircular     membranous 
canal. 
15,16,17.  Acoustic   or  auditive   nerve. 

Figure  No.  2. 

I,  2.  Origin  and  end  of  the  helix. 

3.  Antihelix. 

4.  Antitrajus. 

5.  Tragus. 

6.  Lobe  of  the  outer  part  of  the 

ear. 

7.  It  points  to  the  navicular  pit, 

and  is  in  front  and  over  the 
wing. 

8.  Shell. 

9.  Outer  auditive  duct. 

flGURE   No.   3. 

1.  Swelling  of  the  upper  semicir- 

cular canal. 

2.  Swelling  of  the  outer  canal. 

3.  Swelling  of  the  lower  canal. 

4.  Upper      semicircular      membra- 

nous canal. 
5-  Outer  membranous  canal. 

6.  Lower  membranous  canal. 

7.  Spaces     between     the     semicir- 

cular membranous  and  bony 
canals,  supposed  to  be  filled 
with  coatunni  humor. 

8.  Common   duct   formed    by    the 

union  of  upper  and  lower 
membranous  canals. 

9.  Place    where    the    inner    semi- 

circular canal  opens  into  the 
elliptical  urn  of  the  vestibule. 

10.  Elliptical    urn    which    contains 

the: 

11.  Breschid  otocones. 

12.  Spheric     urn     containing     also 

some : 

13.  Otocones. 

1415,16,17,18.  Expansions  of  the  acous- 
tic nerve  to  the  membranous 
canal  and  the  elliptical  urn, 
and  also  the  spheric. 

19.  Turns  of  the  spiral  lamina. 

.20.  Ladder  of  tympjinum. 

21.  Nervous  expansion  to  the  back 
swelling. 


■  22.  Vestibule  ladder. 
23.  Modiolus. 

Figure  No.  4. 

I.  Thickness  of  outer  covering  of 
inner  cavity. 

2,  2.  Vestibule      ladder      or      upper 

cover   of  the  spiral   lamina. 

3,  3.  Tympanum     ladder     or     lower 

cover. 

4.  Hook   of  the  inner  cavity. 

5.  Centre  of  the  infundible. 

6.  Round   opening   communicating 

with  the  tympanum. 

7.  Thickness    of    the    outer    cover 

of  the  vestibule. 
9.  Oval   opening. 

ID.  Orifice  of  the   aqueduct  of  the 
vestibule. 

11.  Lower   semicircular  canal. 

12.  Upper  semicircular  canal. 

13.  Outer  semicircular  canal. 

14.  Swelling  of  the  lower  canal. 

15.  Swelling  of  the  upper  canal. 

16.  Conmion   orifices  of  upper  and 

lower  canals. 
I".  Swelling  of  the  outer  canal. 

Figure  No.  5. 

1.  Normal     size.      The     other     is 

much  enlarged. 

2.  Zone  of  acoustic  nerve. 

3.  Arrangement     of    filaments     in 

the  vesicular  zone. 

5.  Membranous  zone. 

6.  Bony   texture  of  the  modiolu";. 

7.  Opening  between  the  two  lad- 

ders. 

Figure  No.  6. 

1,  I.  Zone  of  the  acoustic  nerve. 

2,  2.  Filaments   of   the   same   in   the 

bony  zone. 

3,  3.  Anastomosis    in    the    vesicular 

zone. 

4,  4.  Membranous  zone. 

5,  5.  Fold  of  outer  edge. 

6,  6.  .'Vxis  of  inner  cavity. 
7.  The  modiolus. 

8,  8.  Outer  bony  walls  of  the  inner 

cavity. 

9,  9.  Bony   layers    of   the    spiral    la- 

mina. 
10.  Vestibule  ladder. 

12.  Hook  of  the  inner  cavity. 

13.  Infundible. 

14.  Horse    hair    passed    through 

the     course     of    the     spiral 
lamina. 


Pig".   1. — view  or  the  labyrinth  In  a  straight         Fig.    2. — View   of  the   left   ear   In  Us   normal 
position,   open   to  show   the   distribution   of   the      state, 
nerves. 


Pig-.    3. — View,    very   much    enlarged,    of   the 


Fig.    4. — View    of    the    labyrinth    on    the    left 


external    phase    of    tlie    bony    labyrinth    of    llie 


^^i^*  wc^.       ,,^^^    v,i    ,1.^;      „,i       ,         w    ,  .....^       side,    open    throughout,    in    order    to    show    Us 

refWlde.  'open',  eiposUig^The  vestibule  a"nd  'its      structure— enlarged. 
contents,    etc. 


Flpr.     T,. — Figure    or    imaginary     plan    of    the  Fig.    6. — Vertical   section  of  the   Inner   cavity 

Inner    cavity    of    the    ear.  of   the    ear,    very    much   enlarged,    showing    ih>' 

arrangement    and    connection    of    the    different 
parts. 

THE  EAR  AND  ORGANS  OF  HEARING 

For  an  explanation  of  the  illustrations  see   text   on    opposite   page. 

475 


476  DISEASES  OF  TTIE  EYE,  EAR  ANB  NOSE. 

to  include  the  auditory  canal  (aj  or  opening  into  the  head,  and  the  deli- 
cate tympanic  membrane  or  drumhead  (b),  which  is  drawn  across  the 
auditory  canal  like  a  curtain,  at  a  depth  of  about  one  inch  and  a  quarter 
from  the  outside. 

The  Ear  Drum. — The  middle  ear,  as  it  has  been  named,  called  also  the 
drum  of  the  ear,  is  bounded  outwardly  by  the  tympanic  membrane,  and 
inwardly  by  the  bony  portion  of  the  labyrinth  or  internal  ear.  It  in- 
cludes the  Eustachian  tube  (c),  which  is  a  fleshy  pipe,  communicating- 
through  the  head  with  the  upper  and  back  part  of  the  throat,  and  it  con- 
tains the  ossicles  or  little  bones  of  the  ear  (d,  e,  and  f). 

Ossicles  or  little  Bones — The  ossicles  are  three  in  number,  and  are 
named  from  their  resemblance  to  the  familiar  objects  after  which  they  are 
called — the  hammer  (d),  the  anvil  (e),  and  the  stirrup  (f).  These  re- 
markable little  bones  play  a  curioiisly  elaborate  part  in  the  mechanism  of 
hearing. 

The  Labyrinth. — The  chief  portions  of  the  internal  ear,  or  labyrinth, 
as  it  is  often  called,  on  account  of  its  perplexing  structure  and  function, 
are  the  cochlea  or  snail-shell  (g),  and  the  semicircular  canals  (h).  The 
appearances  of  these  are  sufiiciently  indicated  by  their  names,  and  their 
positions  can  be  best  understood  by  looking  at  the  adjoining  picture. 

Tse  of  the  Auricle. — The  object  of  the  auricle  in  man  is  to  collect  the 
waves  of  sound,  just  as  the  broad  mouth  of  an  ear-trumpet  does,  and  it 
seems  to  have  no  other  duty  in  the  process  of  hearing.  In  order  to  pre- 
vent, as  far  as  possible,  the  entrance  of  insects  with  the  sound-waves  into 
the  auditory  canal,  the  exterior  opening  of  this  tube  is  guarded  by  stiff, 
coarse  hairs. 

Ear-Wax. — It  is  also  generally  covered  with  a  sticky,  bitter  substance, 
the  ear-wax,  secreted  by  numerous  ceruminous  glands  (i),  apparently  to 
stop,  or  disgust,  any  adventurous  creatures  which  may  attempt  to  make 
their  way  in  toward  the  drum.  This  provision  is  highly  necessary,  be- 
cause the  tympanic  membrane  is  so  exceedingly  sensitive  that  a  very  slight 
touch,  even  from  the  foot  of  a  small  insect,  would  cause  intense  pain. 

iDelicacy  of  the  Drum. — On  account  of  this  great  delicacy  of  the  mem- 
brane of  the  drum,  it  is  unsafe  to  put  any  hard  object  into  the  ear  for 
the  purpose  of  cleansing  it.  Hence,  the  corner  of  a  towel  is  far  better 
to  wipe  out  the  ear  than  an  earjiick  or  any  other  solid  instrument. 

Wax  Plugs Sometimes  a  firm  plug  of  wax  accumulates  in  the  ex- 
ternal auditory  canal,  and  causes  deafness,  which,  however,  can  be  en- 


DISEASES   OF   THE  EAE.  477 

tirely  and  immediately  cured  if  the  hardened  wax  is  removed  by  syring- 
ing with  warm  water. 

Foreign  Objects  in  the  Ear — When  children  put  heads,  grains  of  corn, 
and  so  forth,  into  their  ears,  no  attempt  should  be  made  to  pick  them  out 
with  hairpins  or  bodkins,  lest,  on  the  contrary,  they  bo  pushed  further 
down  the  tube.  It  is  much  wiser  to  send  for  a  physician,  who  is  provided 
with  suitable,  delicate  forceps  for  removing  them  without  risk  of  such  a 
serious  addition  to  the  original  misfortune. 

Insects  in  the  Ear. — If  an  insect  makes  its  way  into  a  person's  ear, 
notwithstanding  nature's  safeguards  against  such  an  accident,  the  patient 
should  at  once  lie  down  on  the  opposite  side  and  have  the  affected  ear 
filled  with  olive  oil,  which  wiU  probably  kill  the  creature  and  cause  it  to 
float  up  to  the  mouth  of  the  auditory  canal,  where  it  can  be  picked  out. 
Oface  of  Auditory  Canal. — The  office  of  tlie  auditory  canal  is  to  convey 
sounds,  after  they  have  been  collected  by  the  aiiricle,  to  the  drum-head, 
which  is  caused  to  vibrate  just  as  that  of  a  soldier's  drum  does  when  it  is 
beaten,  or  rather  as  the  sounding-board  of  a  piano  does  when  the  keys 
are  struck.  The  vibrations  thus  produced  are  transmitted  along  the 
chain  of  ossicles,  that  is  to  say,  the  handle  of  the  malleus  or  hammer, 
being  fastened  to  the  tympanic  membrane,  moves  with  it.  In  thus  moving 
it  tilts  the  incus  or  anvil  slightly  over,  and  this  motion  of  the  anvil  in  its 
turn  causes  a  slight  oscillation  of  the  stapes  or  stirrup. 

The  Stirrup. — But  the  stirrup  is  fastened  by  its  foot-plate  to  the 
membrane  covering  a  little  hole  in  the  bony  Avail  of  the  labyrinth,  called 
the  oval  window,  so  that  any  vibration  of  the  drum-head  or  tympanic 
membrane  is  carried  along  over  this  chain,  or  bridge  of  bones,  to  the  cov- 
ering of  the  oval  window.  Behind  this  latter  membrane  the  whole  laby- 
rinth is  filled  with  a  watery  fluid,  which  bathes  the  terminations  of  the 
auditory  nerve  in  the  cochlea. 

The  Semicircular  Canals — The  exact  use  of  the  semicircular  canals  is 
not  understood,  but  there  is  little  doubt  that  the  fine  hairs  proceeding  from 
cells  found  in  the  cochlea  ai'e  thrown  into  vibrations  by  undulations  trans- 
mitted from  the  membrane  of  the  oval  window  through  the  fluid  contained 
in  the  cavities  of  the  labyrinth.  Then  these  vibrations  of  sound  are  per- 
ceived by  the  delicate  nerve-fibres,  in  whicli  auditory  nerve  terminates, 
very  much  as  the  imdulations  which  constitiite  light  and  color  are  per- 
ceived by  the  filaments  of  the  o])tic  nerve,  where  they  terminate  in  the 
rods  and  cones  of  the  retina.  Obvioiisly,  with  such  a  complicated  and 
excessively  delicate  mechanism  for  carrying  on  the  process  of  hearing. 


478  DISEASES  OF  THE  EYE,  EAE  AND  NOSE. 

the  wonder  is,  not  that  few  people  hear  imperfectly,  but  that  everybody 
is  not  as  deaf  to  all  sound  as  the  world  has  been  in  previous  ages  to  the 
teachings  of  hygiene. 

DISEASES  OF  THE  ATJKICLE  OF  THE  EAR. 

Ear  Tumors. — This  outer  part  of  the  ear  is  the  occasional  seat  of 
gouty  and  otlier  deposits,  which  give  rise  to  prominences  and  irregularities 
of  its  surface ;  it  may  also  bo  affected  with  a  kind  of  vascular  tumor  called 
hajmatoma,  and  still  more  frequently  be  the  seat  of  benignant  and  malig- 
nant or  cancerous  tumors,  and  of  various  malformations. 

Sizes  of  the  Ear. — In  persons  of  slight  and  delicate  organizations,  with 
a  scanty  stock  of  vitality,  the  outer  ear  is  often  exceedingly  small,  altliough 
it  may  be  perfectly  shaped.  In  persons  of  large  build  and  actively  cir- 
culating blood,  the  auricle  is  sometimes  relatively  large,  the  lower  lobe 
being  pendulous  and  of  exaggerated  development. 

What  Large  Lobes  Indicate. — As  a  rule,  a  large  lobe  of  the  ear  indi- 
cates a  free  vascular  supply  of  blood  to  the  brain,  and  is  said  to  be  to 
some  extent  a  sign  of  epilepsy,  and  of  other  kindred  nervous  diseases. 

Danger  from  Earrings — If  people  choose  to  run  the  risk  of  suffering 
from  the  dangerous  little  tumors  which  are  sometimes  caused  by  the 
barbarism  of  wearing  earrings,  they  shoiild  be  very  careful  to  diminish 
the  chance  of  iujiiry  as  much  as  possible  by  having  the  auricle  pierced 
with  a  clean,  bright  instrument,  and  by  preventing  the  cartilage,  which 
sometimes  comes  quite  low  down  in  the  lobe  of  the  ear,  from  being 
wounded. 

Boxing  and  Pulling  Ears — Children  should  never  be  punished  by 
"boxing"  or  pulling  the  ears.  The  former  piece  of  brutality  might  in- 
stantly burst  the  tympanic  membrane,  causing  deafness  for  life,  and  the 
latter  is  liable  to  originate  severe  inflammation  of  the  auricle,  leading  to 
the  same  unfortunate  result. 

ECZEMA  OF  THE  AURICLE. 

Symptoms. — The  symptoms  of  this  affection  are  the  same  as  of  aciite 
eczema  and  the  reader  is  referred  to  the  article  on  that  subject.  There 
is  also  a  chronic  form  in  which  the  skin  is  thickened  and  crusts  are  formed. 

Causes — 1.  Detention,  when  it  is  due  to  nerve-irritation. 

2.  Discharges  from  the  ear  which  irritate  the  auricle. 


DISEASES  OF  THE  EAJJ.  479 

3.  Hoods  by  pressing  the  auricle  against  tlie  side  of  the  head  and  pre- 
venting the  evaporatiou  of  the  perspiration. 

4.  A  chronic  form  sometimes  found  in  old  peojjle  is  due,  likely,  to 
a  weakened  "tone"  of  the  tissues. 

Treatment. — The  treatment  is  the  same  as  in  eczema  of  other  parts 
of  the  body.  Where  it  is  possible,  the  cavise  should  be  removed.  Cleanli- 
ness is  essentia],  but  water  is  contra-indicated  and  the  crusts  should  be 
removed  by  olive  oil.  The  ammoniated  mercury  ointment,  which  is 
oiScial  and  to  be  had  at  all  drug  stores,  should  be  applied  twice  daily  after 
thorough  cleansing.  Cod-liver  oil  and  iron  ai-e  often  used  as  internal 
remedies. 

HEMATOMA  OF  THE  AUKICLE. 

Definition. — This  is  a  swelling  of  the  auricle  in  which  there  is  an 
infusion  of  blood  between  the  cartilage  of  the  auricle  and  the  perichon- 
drium. It  is  frequently  caused  by  traumatism  and  often  occurs  in  the 
insane. 

Symptoms. — The  symptoms  are  swelling  and  slight  pain. 

Treatment — Gruber  recommends,  if  the  blood  is  coagulated,  incising 
the  tumor  and  removing  the  clot.  Painting  with  tincture  of  iodine  is 
advised  for  the  thickening.  Cold  or  warm  applications  may  be  tried  to 
relieve  the  pain. 

MASTOIDITIS. 

This  is  an  inflammation  with  pus  filling  up  the  porous  j)ortion  of 
tlie  mastoid  bone  back  of  the  ear.  It  may  be  primary  or  secondary,  though 
the  latter  is  seldom  observed.  Among  the  predisposing  causes  are  inflam- 
mation of  the  middle  ear,  exanthematous  diseases,  la  grippe,  tuberculosis, 
syphilis  and  pathogenic  infections.  There  are  instances  on  record  where 
it  has  existed  for  months  without  subjective  or  objective  signs,  but  as  a 
rule  it  characteristically  manifests  itself  at  an  early  stage. 

Symptoms — The  symptoms  of  acute  or  primary  mastoiditis  are  heat, 
redness  and  swelling  of  the  skin  behind  the  auricle,  and  tenderness  upon 
pressure.  This  primary  disease  usually  terminates  in  three  or  four  days 
in  recovery  or  else  in  an  involvement  of  the  deeper  structures  with  the 
formation  of  an  abscess. 

In  the  secondary  form  the  symptoms  vary  in  difi^erent  individuals, 
manifesting  themselves  before  or  after  spontaneous  rupture  of  the  drum. 
Tenderness,  persistent  or  remittent  pain  and  redness  with  swelling  over 


480  DISEASES  OF  THE  EYE,  EAK  AND  NOSE. 

the  mastoid  and  bulging  of  the  superior  and  posterior  auditory  canal,  are 
the  most  prominent  symptoms.  The  temperature  varies  from  normal  to 
10-i  degrees  F.  and  is  much  higher  in  infants  as  a  rule  than  in  adults. 
If  the  ease  be  observed  before  rupture  the  drum  will  be  seen  bulging  in 
the  posterior  and  superior  portions.  After  the  rupture  of  the  drum  the 
discharge  from  the  ear  is  usually  profuse. 

Treatment. — The  treatment  of  mastoiditis  is  divided  into  medical 
and  surgical — ^by  medical  in  this  instance  being  meant  minor  surgical 
methods  and  the  application  of  antiphlogistic  remedies.  When  early  ob- 
served effort  should  be  made  to  abort  acute  inflanmiation  of  the  mastoid  by 
cold  application  by  use  of  the  Leiter  coil  or  cracked  ice  bags.  This  should 
be  continued  for  twenty-four  hours  without  interruption.  The  patient 
should  be  absolutely  confined  to  bed  and  given  light  diet  and  gentle  purga- 
tiva  If  the  pain  and  inflammation  continue  after  forty-eight  hours  an 
operation  will  in  most  cases  be  necessary.  To  relieve  elevation  of  tempera- 
ture, acetanilid  in  five-gTain  doses  may  be  repeated  hourly  until  fifteen 
grains  have  been  taken. 

Mastoiditis  is  of  suck  serious  character  and  is  liable  to  such  com- 
plications that  if  it  be  suspected  the  best  medical  advice  obtainable  should 
be  secured  without  delay,  for  none  but  an  expert  can  properly  care  for 
the  sufferer  from  this  disease  and  know  just  whether  an  operation  be 
necessary  or  not. 

DISEASES  AND  AFFECTIONS  OF  THE  AUDITORY  CANAL 

BOILS  OR  FURUNCULOSIS. 

Character. — This  is  one  of  the  most  painful  maladies  that  flesh  is  heir 
to.  It  is  rendered  so  frightfully  painful  by  the  fact  that  it  is  shut  in 
between  a  layer  of  strong  cartilage  and  solid  bone.  Probably  the  most 
common  cause  of  abscess  in  the  ear  is  taking  cold,  although  picking  the 
ears  with  hard,  sharp  instruments  sometimes  seems  to  excite  it.  As  it  is 
impossible  to  tell  which  side  of  the  auditory  canal  the  abscess  is  going  to 
form,  early  in  the  case,  lancing  must  be  deferred. 

Treatment — As  a  rule,  all  that  can  be  afforded  in  the  way  of  relief 
is  gained  by  hot  poultices  made  out  of  ground  flaxseed,  bread  and  milk, 
or  little  bags  of  hops  dipped  in  hot  vinegar  and  changed  very  frequently, 
or  as  soon  as  they  grow  cool.  As  soon  as  the  abscess  is  well  localized  it 
should  be  opened  by  a  physician,  thereby  relieving  the  patient  of  a  great 
deal  of  suffering.     In  the  meantime  some  respite  and  sleep  may   be  ob- 


FOREIGN   BODIES   IN   THE   EAE.  481 

tained  by  the  use  of  opium  suppositories  containing  one  grain  eacli  useil 
every  four  hours,  or  hypodermic  injections  of  one-eighth  to  one-half  of  a 
grain  of  morphia. 

BONY  TUMOR  OR  EXOSTOSIS. 

Causes. — An  exostosis  or  bony  tumor  occasionally  springs  from  the 
walls  of  the  auditory  canal,  pushing  the  mucous  lining  before  it,  and 
filling  up  part  or  all  the  calibre  of  the  tube.  It  is  most  frequently  mot 
with  in  people  of  a  rheumatic  or  gouty  tendency.  Until  chiseled  away 
it  is  sometimes  very  painful  and  a  serious  obstacle  to  hearing. 

WAX  OR  IMPACTED  CERUMEN. 

Causes. — This  is  the  name  given  to  that  condition  in  which  the  canal 
is  partially  or  completely  filled  with  ear-wax.  The  wax  may  be  very  hard 
and  may  be  mixed  with  dirt  and  dust.  It  is  caused  sometimes  by  the 
shape  of  the  canal,  and  on  the  other  hand  is  often  due  to  one's  occupation. 

Symptoms — Deafness,  dizziness  and  buzzing  in  the  ear  are  frequently 
complained  of,  but  to  make  sure  that  impacted  wax  is  i^resent  it  should 
be  seen.    It  appears  as  a  dark  mass  in  the  canal. 

Treatment — If  the  wax  is  soft,  it  may  be  removed  by  repeated  syring- 
ings  with  warm  water.  If  it  is  hard,  the  canal  should  be  filled  with  warm 
olive  oil  and  then  the  syringing  tried.  An  instrument  of  any  kind  should 
never  be  introduced  into  the  canal  for  its  removal  by  the  unskilled  hand. 

FOREIGN  BODIES  IN  THE  EAR. 

Symptoms. — Inanimate  foreign  bodies,  such  as  beads,  buttons,  grains 
of  corn,  etc.,  give  rise  to  the  same  symjjtoms  as  impacted  wax.  In  tlio 
case  of  grains,  water  tends  to  swell  them  and  so  makes  their  removal  more 
difficult.    In  such  cases  the  surgeon  should  be  called  upon. 

.Use  of  Syringe — Insects  occasion  great  pain  which  may  simulate 
intense  neuralgia,  or,  by  a  reflex  action,  may  refer  the  pain  to  the  teeth 
and  so  lead  one  astray.  The  syringe  should  be  used  and  heated  water  is 
very  grateful  to  the  patient,  soothing  the  inflamed  part.  Great  care  is 
necessary  that  the  water  is  not  hot  enough  to  do  injury. 


tt 


482  DISEASES    OF    THE   EYE,    EAE   AND    NOSE, 

DISEASES  OF  THE  TYMPANIC  MEMBRANE  OF  THE  EAR 

EARACHE. 

Character — Inflammation  of  the  drum-head  is  an  acutely  painful 
affection,  sometimes  attended  "with  fainting  fits  in  its  early  stages,  and 
usually  resulting  in  deafness  because  the  membrane  is  left  thickened,  and 
therefore  incapable  of  properly  responding  to  the  vibrations  of  sound. 

Treatment. — Leeching,  followed  by  blisters  behind  the  ear,  or  on  the 
nape  of  the  neck  and  opium  internally  or  hypodermically,  to  mitigate  the 
suffering,  which  is  often  Tery  severe,  will  prove  of  great  value.  Hot 
applications  to  the  ear  in  the  shape  of  bags  of  hops,  a  stove  lid  wrapped 
in  flannel,  or  the  hot-water  bottle  may  be  sufficient  to  give  relief. 

Treatment  of  Children. — In  young  children  a  hot  foot  bath  will  relieve 
by  dilating  the  small  blood-vessels  of  the  lower  extremities  and  so  drawing 
some  of  the  blood  from  the  inflamed  area.  As  hot  water  as  can  be  borne 
may  be  dropped  into  the  ear.  A  two  per  cent,  solution  of  cocaine  will 
generally  relieve  the  pain. 

PERFORATION  OF  THE  TYMPANIC  MEMBRANE. 

Causes. — This  is  especially  liable  to  occur  during  the  course  of  scarlet 
fever  from  suppuration  of  the  middle  ear,  and  if  neglected  leads  to  per- 
manent deafness.  Hence,  in  scarlatina,  the  ears  of  a  child  should  be 
carefully  examined  daily  with  the  little  conical  ear-speculum,  if  there 
is  the  slightest  complaint  of  pain  in  them,  in  order  to  prevent  this  disaster 
by  early  puncture  of  the  drum-head,  which  allows  the  escape  of  the  im- 
prisoned pus,  and  so  saves  the  organ  of  hearing.  Still,  when  the  per- 
foration remains  in  the  drum-head  the  auditory  sense  is  often  only  slightly 
impaired. 

Treatment. — Suppurating  or  running  ears  need,  above  all  things, 
that  cleanliness  should  be  maintained  as  much  as  possible.  If  pus  remains 
in  the  middle  ear,  a  chronic  inflammation  is  kept  up  and  normal  tissue  is 
destroyed — eaten  away  as  one  might  say.  Hearing  becomes  more  and 
more  difficult  and  lif^is  constantly  in  jeopardy,  for  the  bone  may  become 
affected  and  the  brain  finally  exposed  to  infection  and  a  brain-abscess 
develop.  Cleanliness  may  be  maintained  usually  by  washing  out  the  ear 
with  a  hot  solution  of  carbolic  acid  two  or  three  times  daily.  A  two  per 
cent,  strength  is  sufficient.     If  this  fails  to  cure  the  ear,  whick  would 


DISEASES    OF    THE    NOSE.  483 

be  evidenced  hj  a  cessation  of  all  symptoms,  especially  pain  and  discharge, 
a  specialist  should  be  at  once  consulted.  Dead  or  necrosed  bone  may  be 
present,  or  granulation  tissue — "proud  flesb," — and  shoidd  be  removed  as 
soon  as  possible. 

Thickening  of  Tympamiin — Thickening  and  condensation  of  the  tym- 
panic membrane  are  liable  to  occur  in  advanced  life,  the  delicate  skin 
forming  the  drum-head  undergoing  a  slow  process  of  change,  by  which  it 
loses  its  elasticity  and  becomes  firm  and  hard  almost  like  the  nail  of  the 
finger.  Of  course,  in  this  condition  the  vibrations  into  which  it  should 
naturally  be  thrown  are  rendered  very  imperfect,  and  the  hearing  is 
correspondingly  defective  in  old  people  who  are  the  subjects  of  this  de- 
generation. 

DISEASES  OF  THE  EUSTACHIAN  TUBE. 

Causes. — The  Eustachian  tube  is  liable  to  inflammation  from  exten- 
sion of  disease  from  the  throat,  even  such  a  simjjle  irritation  as  that  of 
a  common  cold.  It  is  also  subject  to  obstruction  and  contraction,  so  that 
the  air  cannot  pass  freely  through  it  into  the  cavity  of  the  tympanum, 
as  it  should  do  in  health.  When  this  takes  place,  the  vibration  of  the  drum 
is  interfered  with,  there  is  pressure  within  the  cavity,  and  consequently 
a  sense  of  fullness  and  deafness  is  experienced,  which  is  very  oppressive. 

Treatment. — This  distressing  condition  can  often  be  greatly  relieved 
by  calling  in  a  skillful  aurist,  who  may  pass  a  probe  or  hollow  tube  along 
the  Eustachian  canal  into  the  middle  ear,  and  so  restore  the  communica- 
tion of  the  latter  with  the  external  air. 

Diseases  of  the  Middle  Ear — ^Diseases  of  the  middle  ear  and  of  the 
internal  ear  comprise  inflammation,  ulceration  and  abscess.  All  these 
are  very  painful,  difiicult  to  recognize  with  certainty,  and,  as  a  rule, 
beyond  the  power  of  any  but  the  most  skillful  treatment.  In  every  case, 
an  experienced  aurist  should  therefore  be  immediately  called  in,  and  until 
he  arrives  the  severity  of  the  pain  may,  perhaps,  be  held  in  check  by  some 
of  the  means  suggested  when  speaking  of  abscess  of  the  auditory  canal. 

DISEASES  OF  THE  NOSE. 

Anatomy  of  the  Nose — The  organ  of  the  sense  of  smell  is  much  more 
extensive  than  people  who  have  never  studied  anatomy  imagine.  Instead 
of  being  merely  a  triangular  projection  of  some  two  or  three  inches  long, 
and  an  inch  or  an  inch  and  a  half  high,  occupying  the  middle  of  the  face 
it  is  a  large  double  cavity  reaching  far  back  into  the  head,  and  communi- 


■tS4  DISEASES    OF    TIIK    KYK,    K^Ul    AND    xNOSE. 

eating  by  the  posterior  uares  or  hinder  nostrils  willi  tl;  ■  upper  part  of  the 
throat.  Tlio  external  portion  of  the  nose  is  composed  at  its  \ipper  third 
of  small  bones,  which  are  continued  at  its  lower  part  by  plates  of 
cartilage. 

Nose  Bones  and  Cartilages. — These  cartilages  and  bones  are  covered 
on  the  outside  with  a  thin  skin,  and  on  the  inside  with  a  mucous  mem- 
brane, which,  in  the  deeper  recesses  of  the  cavity  is  identical  and  con- 
tinuous with  that  of  the  mouth  and  throat.  The  external  division  between 
the  two  nostrils  is  carried  \ipward  and  backward  by  a  flat,  very  thin  bone 
named  the  vomer ;  and  the  sides  of  the  two  cavities,  which  are  continuous 
with  the  exterior  nostrils,  are  partly  filled  up  with  soft,  spongy  processes 
of  boue,  three  of  which  are  called  the  turbinated  bones,  because  they  are 
rolled  up  like  a  scroll. 

The  Mucous  Membrane These  turbinated  bones  are  covered,  like  the 

rest  of  the  nasal  cavities,  with  a  mucous  membrane,  named  the  Schnci- 
derian  membrane,  richly  supplied  with  blood-vessels,  which  approach 
very  near  its  soft  and  delicate  surface.  It  is  from  these  small,  but  active, 
little  blood-vessels  that  the  hemorrhage  usually  comes  iu  bleeding  from 
the  nose. 

The  Olfactory  Nerves. — The  nerves  of  smelling,  called  the  olfactory 
nerves,  enter  the  upper  part  of  the  nose  through  openings  in  the  sieve-like 
bone,  which  forms  the  roof  of  the  nasal  fossa.  After  passing  into  the 
nose,  these  olfactory  nerves  divide  up  into  a  great  number  of  tiny  branches, 
which  run  along  under  the  surface  of  the  Schneiderian  membrane,  and  are 
spread'out  upon  the  superior  and  middle  turbinate  bones,  and  on  the  sides 
of  the  partition  between  the  two  nasal  cavities.  The  great  use  of  the  tur- 
binated bones  and  processes  is  to  furnish  a  large  extent  of  surface  upon 
which  these  branches  of  the  olfactory  nerve  can  be  expanded. 
*"■  Functions  of  the  Olfactories. — And  this  spreading  out  of  the  olfactory 
nerve  is  evidently  iu  order  that  the  sensitive  filaments  uiay,  on  occasion, 
come  in  contact  with  as  large  a  number  as  jiossible  of  the  exceedingly 
minute,  odorous  particles  which  many  substances,  such  as  musk  or  cam- 
phor, are  constantly  giving  off  in  such  abundance. 

How  We  Smell. — These  odorous  particles  have  the  power  of  affecting 
the  terminal  filaments  of  the  olfactory  nerves  in  different  ways,  which 
we  recognize  as  the  agreeable  or  disagreeable  odors  of  the  objects  from 
Mhieh  they  originate.  The  excessive  minuteness  of  such  particles  may 
be  comprehended  from  the  fact  that  tlie  a]>artment  of  the  Empress  Jo- 
sephine iu  one  of  the  French  Imperial  palaces  was  found,  after  twenty- 


NASA  I.   CATAKKll.  485 

four  years  of  disuse,  to  give  off  a  distinct  odor  of  the  musk  employed  by 
tliat  uui'ortuuate  lady  when  slie  occupied  it. 

Uses  of  the  Sense  of  Smell — The  power  of  distinguishing  odors,  which 
to  some  animals,  including  all  those  beasts  which  pursue  their  prey  by 
scent,  is  one  of  the  most  vitally  important,  chiefly  serves  as  a  means  of 
gratification  or  its  opposite  to  human  beings. 

Hygienic  Office  of  Smell. — But  altliough  the  sense  of  smell  does  not  in 
civilized  communities  contribute  anything  toward  sustaining  life  by  help- 
ing us  to  secure  food,  it  has  a  very  useful  hygienic  oiRce,  which  should 
never  be  forgotten,  in  guarding  us  against  some  of  the  most  common  and 
dangerous  causes  of  disease,  in  foul  air  and  polluted  water. 

Nose  as  a  Warming'  Organ — Besides  this  the  nose  has  an  important 
work  to  do  in  warming  and,  to  some  extent,  jiurifying  the  air  we  breathe, 
as  tliat  air  is  drawn  through  the  narrow  and  winding  passages  among  the 
turbinated  bones.  The  Schneiderian  membrane  over  which  this  air  passes 
being  generally  moist,  and  more  or  less  covei'ed  with  adhesive  mucus, 
helps  to  catch  not  only  the  odorous  particles,  but  larger  and  more  hurtful 
impurities,  and  so  is  quite  mechanically  a  valuable  protector  to  hiimau 
health. 

NOSE  BLEED  OR  EPISTAXIS. 

Causes. — Nose  bleed  may  be  due  to  a  blow,  picking  the  nose,  the  pres- 
ence of  a  foreign  body  in  the  nose,  or  to  the  use  of  instruments  in  the  nose. 
Diseased  conditions  within  the  nose  often  occasion  it.  In  girls  it  uuiy 
replace  the  natural  menstruation.  Diseases  of  the  heart,  liver  and  kid- 
neys niay  give  rise  to  it. 

Treatment. — In  cases  of  slight  bleeding,  pressure  or  the  snuiUng  of 
ice-water  may  suffice.  If  these  fail,  cotton  dipped  in  a  one  to  ten  thousand 
solution  of  adrenalin,  should  be  packed  into  the  nostril  and  kept  there 
for  ten  or  fifteen  minutes.  Iron,  tannic  acid  and  alum — the  remedies  our 
grandmothers  used — are  now  supplanted  by  this  modern  drug  which  does 
not  irritate  the  delicate  lining  of  the  nose  as  the  old  remedies  did.  If  the 
adrenalin  solution  does  not  check  the  hemorrhage,  it  may  be  necessary  for 
the  physician  to  plug  up  both  the  anterior  aud  posterior  nostrils  by  the 
aid  of  an  ingenious  little  instrument  which  has  been  devised  for  that 
purpose. 

NASAL  CATARRH. 

Forms  and  Causes. — "Catarrh"  is  a  word  derived  from  the  Greek  word 
l-nf.nrheo,  nu'aiiiug  to  flow  down,  and  is  used  in  medicine  to  designate  a. 


48fi  DISEASES   OF   THE  EYE.    EAR   AND   NOSE. 

particular  form  of  iuflammation  of  the  mucous  membrane.  It  has  many 
forms  and  is  due  to  many  causes,  and  no  one  has  ever  found  nor  ever  will 
find  one  remedy  for  catarrh.  This  truth  should  be  better  and  more  gen- 
erally known  by  the  intelligent  public 

Causes. — As  causes  of  catarrh  may  be  mentioned : 

1.  Climatic  influences.  Many  patients  lose  their  catarrh  when  they 
change  from  one  climate  to  another. 

2.  Inherited  predisposition.  One  caimot  inherit  catarrh,  but  the 
weakness  of  the  mucous  tissues  may  be  inherited  and  so  predispose  to  the 
affection. 

3.  Indigestion,  constipation,  intestinal  parasites  (worms),  heart, 
limg,  liver  and  kidney  diseases  are  often  provocative  of  a  catarrhal  state 
of  the  nasal  mucous  membrane. 

4.  Many  fevers  at  their  beginning  or  during  their  course  are  accom- 
panied by  acute  catarrhal  disturbance.  Typhoid  fever,  measles,  and  scar- 
latina are  examples. 

5.  Deformity  within  the  nasal  chambers  is  one  of  the  most  frequent 
factors,  and  local  remedies  are  of  no  avail  as  far  as  a  permanent  cure  is 
concerned.  In  these  cases  the  only  sensible  treatment  is  the  correction 
of  the  deformities,  thus  bringing  the  organ  into  a  condition  as  near  the 
normal  as  possible. 

Catarrh  as  the  Cause  of  Tuberculosis. — There  is  a  general  belief  that 
catarrh  is  to  blame  for  the  great  majority  of  the  cases  of  consumption. 
This  needs  some  modification  before  it  is  to  be  accepted.  Surroundings, 
family  predisposition,  climate,  and  weak,  non-resisting  tissues  are  as 
much  to  be  blamed  for  the  occurrence  of  this  terrible  malady.  Catarrh 
does,  however,  play  some  part  as  a  factor. 

liability  of  Infection. — Professor  Osier,  of  Johns  Hopkins  Univer- 
sity, says  on  this  subject:  "The  liability  of  infection  in  the  cervical  and 
bronchial  glands  in  children  is  pi-obably  associated  with  the  common  oc- 
currence of  catarrhal  processes  in  the  throat  and  bronchi."  This  mean? 
that  neglect  of  catarrhal  conditions  in  a  child  makes  that  child  more  likely 
to  be  infected  with  tuberculosis,  and  if  the  family  has  a  history  of  tuber- 
culosis there  is  all  the  more  reason  for  thoroughness  of  treatment  of  the 
existing  catarrhal  condition. 


FETID    CATAEEH    OE   OZENA.  48^ 


FETID  CATAKRH  OR  OZENA, 

Character. — This  is  a  term  applied  to  a  form  of  catarrh  characterized 
by  a  horrible  and  peculiar  stench  and  the  formation  in  the  nose  of  crusts 
of  dried  secretions  upon  which  the  fetor  depends. 

Causes — In  some  cases  it  is  due  to  a  constitutional  disease,  as  syphilis. 
In  the  majority  of  instances,  however,  it  is  the  continuation  of  a  catarrhal 
inflammation,  in  which  the  mucous  membrane  shrinks— atrophies — and 
the  secretions  therefrom  are  changed,  becoming  more  tenaciovis  and  con- 
centrated. 

Symptoms — These  are  the  crusts  and  the  peculiar  fetor  mentioned 
above. 

Treatment. — Cleanliness  is  the  great  sine  qua  non — a  fact  easily  re- 
membered when  one  realizes  that  the  fetor  is  from  the  decomposing  crust. 
To  detach  the  crusts  various  washes  have  been  prescribed.  A  solution  of 
bicarbonate  of  soda  is  a  good  solvent  and  may  be  prescribed  as  follows : 

R. — Bicarbonate  of  soda    2  ounces 

Common   table   salt    I  ounce 

Menthol     4  grains 

Mix.     Directions:    Half  a   teaspoonful   in   a   cup   of   warm 

■water,   snuffed   up  the  nose  until  the  nostrils   are   clear.     Use 

twice  daily. 

Or, 

R. — Bicarbonate  of  soda  2  ounces 

Biborate   of   soda    V>  ounce 

Salicylic  acid    I  drachm 

Menthol    4  grains 

Mix.     Directions:    Same  as  for  preceding  presc.iption. 

Or, 

R. — Liquor  antiseptic  alka 6  ounces 

Use  freely  night  and  morning  with  an  atomizer. 
Or, 

R. — Dobell's   Solution. 

Dilute  with  three  or  four  parts  of  warm  water  and  use 
as  a  nose  wash. 

Steam  Inhalations. — If  these  washes  are  not  effectual  in  removing 
the  crusts,  steam  or  hot  vapor  inhalations  may  be  tried.  In  obstinate 
cases  it  is  often  necessary  to  remove  the  crusts  with  some  force,  either 


488  DI8EASKS    OF    THE   EYE,    EAR    AXD    NOSE. 

with  cotton  on  a  probe  or  with  forceps.  After  the  crusts  are  gotten  rid 
of,  antiseptics  and  deodorizants  should  be  employed.  Weak  solutions  of 
potassium  permanganate,  bichloride  of  mercury,  and  when  the  patient  can 
stand  the  pain,  a  one-half  to  a  one  per  cent,  solution  of  formaldehyde. 

Removal  of  Dead  Bone. — -When  the  fetor  is  due  to  dead  bone,  the  dead 
bono  should  be  at  onoe   removed. 

Treatment  of  Syphilitic  Catarrh. — If  a  syphilitic  taint,  cither  in- 
lu  riii-d  or  acquired,  is  the  foundation  of  the  odor,  proper  constitutional 
trc.iiinent  should  be  instituted  at  once  and  maintained  until  long  after  the 
]ia,-al  symptoms  have  disappeared. 

GRAPE-LIKE  TUMORS  OR  NASAL  POLYPS. 

Causes. — Nasal  polyps  are  grape-like  tumors  which  are  dependent 
from  the  upper  and  outer  wall  of  the  nose — on  the  inside — and  are  sup- 
])osed  to  be  one  of  the  possible  results  of  chronic  inflammation  of  the 
lining  mucous  membrane.     They  are  rarely  seen  before  the  fifteenth  year. 

Symptoms — When  small  they  may  present  no  sjTuptoms.  If  they  are 
large  they  may  cause  obstruction  to  the  respiration,  pervert  the  nasal 
secretions,  cause  headaches,  give  a  nasal  twang  to  the  voice,  and,  in  some 
cases,  undoubtedly  provoke  asthmatic  attacks. 

Treatment. — The  treatment  is  removal,  which  may  be  accomplished 
by  twisting  the  tumor  free  from  its  attachment,  by  cutting  it  at  its  base, 
or  preferably  by  using  a  wire  snare. 

ACNE  ROSACEA. 

Nature. — This  is  a  skin  disease  affecting  usually  the  skin-covering 
of  the  nose,  is  chronic,  and  is  characterized  by  redness,  thickening  of  the 
ekin,  and  more  or  less  acne. 

Causes. — These  are  various.  According  to  Brof.  Van  Harlingen, 
"in  early  life  it  is  generally  due  to  anemia  and  debility,  nervous  prostra- 
tion or  dyspepsia.  In  later  life  the  use  of  sinrituous  liquors  is  often  the 
cmisc.  and,  perhaps  nearly  as  often,  dyspepsia  in  some  of  its  forms."  In 
women,  disturbances  of  the  menstrual  function,  even  pregnancy,  may  act 
as  a  causative  factor. 

Treatment — To  be  successful  persistence  in  treatment  is  often  neces- 
sary. The  first  thing  to  be  done  is  to  remove  the  cause.  "Uterine  and 
menstrual  derangements  are  to  be  looked  after,  the  stomach  and  bowels 
kept  in  good  order,  and  all  hygienic  measures  used  to  improve  the  general 


WAETS   ON    THE    NOSE  489 

health.  Alcoholic  and  malt  liquors  are  to  be  totally  eschewed.  Tea  and 
coffee  should  be  drunk  in  moderation  and  not  strong.  Inveterate  tea 
drinkers  are  very  apt  to  have  red  noses." 

The  Favorite  Drug.- — The  favorite  drug  both  for  internal  and  external 
use  in  this  disease  is  ichthyol.  Internally  it  may  be  administered  in  ])ep 
permint  vrater,  equal  parts  of  each,  ten  drops  being  the  dose  and  given 
every  four  to  six  hoiirs.  Locally  it  may  be  used  as  an  ointment  or  as  a 
paint : 

R. — Ichthyol     I  drachm 

Subnitrate    of   bismuth    i  drachm 

Ammoniated  mercury   i  drachm 

Vaseline    lo  drachms 

Mix.     Apply  freely  before  retiring.     (Dr.  Latoir.) 

R. — Ichthyol     _ I  ounce 

Oil  of  eucalyptus   lo  drops 

Oil  of  bergamot   S  drops 

Mix.     Paint  on  at  night;  wash  off  in  morning  with  soap 
and  warm  water;  then  apply  dusting  powder.     (Merk.) 

Vleminck's  solution  is  recommended  by  Stelwagon,  diluted  one  to 
ten  parts  of  water.     The  formula  for  the  strong  solution  is: 

R. — Calcis     «  . . . .   %  ounce 

Sublimed   sulphur    i  ounce 

Water    lo  ounces 

Boil  down  to  six  ounces  and  filter.     Apply  locally  three 
or  four  times  a  day. 

ADENOID  GROWTHS, 

These  growths  resemble  proud  flesh.  They  grow  in  the  back  parr 
of  the  nostrils,  and  are  generally  due  to  catarrhal  conditions.  They  block 
the  nose  passages,  producing  snoring  and  difficult  breathing.  The  treat- 
ment consists  in  scraping  them  away  witli  a  scoop,  or  even  with  the 
finger,  to  the  great  relief  of  the  patient. 

WARTS  ON  THE  NOSE. 

Treatment. — Warts  in  this  locality  are  often  mistaken  by  the  laity 
for  cancer  and  afford  the  charlatan  and  the  advertising  doctor  an  op- 
portunity to  make  "cures"  of  this  greatly  feared  disease.  Warts  in  this 
locality  are  treated  just  as  in  other  parts  of  the  body. 


PART  V  OF  BOOK  IV 

Tells  of  the   circulatory  and  absorbent  systems  of 
the  body  and  the  affections  to  which  they  are  subiect. 


Addison's  Disease    So6 

Symptoms   of    506 

Treatment   of    506 

Aneurism     508 

Causes  of  50& 

Symptoms  of 508 

Treatment  of  509 

Angina  Pectoris   S19 

Symptoms    SiP 

Treatment  of    519 

Arteritis    520 

Symptoms  of   520 

Treatment   of    520 

Asthma,  Heart   S20 

Ausculation    494 

Bloody  Tumor    S08 

Chronic   Pericarditis    502 

Treatment  of  S02 

Valvular  Diseases   S16 

Symptoms  of  Si7 

Treatment  of Si7 

Cyanosis    497 

Dilatation  of  the  Heart S14 

Symptoms  of  S 14 

Treatment  of   SiS 

Embolism    507 

Symptoms   of    So7 

Treatment   of    507 

Endocarditis     502 

Causes  of  503 

Diet  in  SoS 

Symptoms   of    503 

Treatment   of    505 

Enlargement  of  the  Heart  515 

Diet  in  516 

Symptoms  of 515 

Treatment   of    516 

Fainting    518 

Symptoms  of  518 


Treatment  of 518 

Goitre    507 

Symptoms  of   507 

Treatment   of    508 

Grave's  Disease   507 

Heart   Asthma    520 

Symptoms  of  520 

Treatment  of 520 

Palpitation  of   497 

Pang     519 

Inflammation      of     the      Lymphatic 

Glands    512 

Symptoms  of 512 

Treatment   of    513 

of  the  Veins   509 

Leucocythemia    514 

Causes  of   514 

Symptoms   of    514 

Treatment  of   514 

Lymphatic  Glands.  Inflam  —  ation  of.512 

Palpitation  of  the  Heart 497,  518 

Symptoms  of   518 

Treatment   of    519 

Pericarditis     497 

Chronic     502 

Diet  in   502 

Symptoms  of   500 

Treatment   of    501 

Phlebitis    509 

Symptoms    of    509 

Treatment  of   509 

Splenitis    513 

Symptoms    of    513 

Treatment   of    S14 

Syncope    518 

Tumor,    Bloody    508 

Valvular  Disease,  Chronic 516 

Veins,  Inflammation  of  509 


ILLUSTRATIONS 


Arteries,   The    S" 

Heart,   The    499 

Heart  Cavities,  Right  Side   502 


Internal   Organs    S04 

Valves  of  the  Heart  516 


491 


CURATIVE    MEDICINE 


PAET  V. 
DISEASES  OF  THE  CIRCULATORY  AND  ABSORBENT  SYSTEMS 

New  Medical  Views. — Affections  of  this  class  were,  until  recently, 
supposed  to  present  symptoms  of  very  much  the  same  general  character, 
and  therefore  to  constitute  a  class  of  maladies  which  possessed  consider- 
able unity  in  their  intrinsic  nature.  They  are  now,  however,  found  to 
consist  of  a  variety  of  distinct  affections  producing  very  different  and 
sometimes  opposite  symptoms.  Thus  hypertrophy  produces  increased 
and  dilatation  diminished  force  of  the  circulation.  Tn  order,  therefore,  to 
appreciate  the  value  and  familiarize  ourselves  with  the  nature  of  each 
class  of  symptoms,  it  is  necessary  to  study  the  several  affections  in  an 
isolated  form.  We  are  thus  enabled,  on  meeting  with  a  compound  case — 
one  consisting  of  a  complication  of  several  of  the  simple  affections — to 
analyze  or  unravel  the  symptoms,  ascertain  the  relative  importance  of 
each  class,  and  in  this  manner  establish  rational  and  secure  principles  of 
treatment.  In  conformity  with  this  view,  the  various  articles  on  the 
diseases  of  the  circulatory  and  absorbent  systems,  instead  of  being  as- 
sembled under  the  present  head,  are,  for  facility  of  reference,  diffused 
alphabetically  throughout  the  work. 

ACTION  OF  THE  HEAKT. 

Hearing  the  Heart-Beats. — If  we  apply  the  ear,  with  or  without  the 
stethoscope,  to  the  cardiac  region  of  a  person  in  health,  we  perceive  most 
distinctly  a  series  of  sounds  of  a  very  marked  and  peculiar  kind,  sub- 
divided into  uniform  parts  by  a  brief  interval  of  silence  after  every  second 
Bound.    Two  sounds  follow  each  other  instantly,  or  within  so  short  a  space 

(493) 


494  DISEASES  OF  THE  CIECTTLATOKT  SYSTEM. 

that  the  ear  separates  them  rather  by  difference  in  their  quality  than  from 
the  intervention  of  any  notable  cessation  of  sound;  then  ensues  a  brief 
but  well-marked  pause,  which  is  again  succeeded  by  the  first  of  the  timo 
sounds.  This  series  of  sounds  may  be  perfectly  well  represented,  as  t) 
rhythm,  by  musicial  notation.  The  relative  duration  of  the  sovmds  and 
pause  is  rei^resented  by  Lawrence  to  be  nearly  as  follows:  the  whole 
being  divided  into  four  parts,  two  of  these  are  occupied  by  the  first  sound, 
and  one  by  the  second  sound  and  the  pause  respectively. 

Difference  in  the  Sounds — The  two  sounds  differ  in  kind  as  well  as 
in  duration.  The  first  is  nearly  double  the  length  of  the  second,  of  a 
graver  and  more  siibdued  tone,  rather  louder  at  its  commencement  than 
at  its  termination,  as  if  it  was  about  to  die  away,  when  suddenly  inter- 
rupted by  the  second.  The  second  is  brief,  smart  and  clear,  like  a  gentle 
tap  with  the  pulp  of  the  finger  on  a  solid  table,  or  like  the  sharp  sound 
produced  by  the  pulling  back  of  a  valve,  the  cracking  of  a  whip,  or  the 
lapping  of  a  dog.  Exactly  synchronous  with  the  first  sound,  there  is  per- 
ceptible, in  most  cases,  a  well-marked  impulse  or  shock  communicated 
evidently  by  a  body  in  motion  within,  in  the  walls  of  the  chest.  Every 
one  acquainted  with  anatomy  and  physiology  will  at  once  conclude  that 
the  sounds  and  impulse  just  described  are  produced  by  the  motions  of 
the  heart;  and  this  conclusion  will  be  justified  and  confirmed  by  an  ex- 
amination of  the  pulse  in  the  extremities.  It  will  be  found,  in  all  healthy 
subjects,  that  there  is  an  invariable  connection  between  the  sounds  and  the 
pulse ;  every  stroke  of  the  latter  corresponding  very  accurately  with  every 
repetition  of  the  twin  sounds;  as,  under  every  variation  of  circumstances 
as  to  loudness,  frequency,  and  so  forth,  the  same  exact  relation  is  per- 
ceived, it  cannot  be  doubted  that  there  exists  an  essential  physical  con- 
nection between  the  causes  of  the  sounds  and  the  pulse. 

Rhythm  of  the  Heart — The  first  motion  of  the  heart  which  interrupts 
the  interval  of  repose  is  the  auricular  systole.  It  is  a  very  slight  and 
brief  contractile  movement,  more  considerable  in  the  auricular  appendix 
than  elsewhere,  and  propagated  with  a  rapid  vermicular  motion  toward 
the  ventricle,  in  the  systole  of  which  it  terminates  rather  by  continuity  of 
action  than  by  the  sucession  of  a  new  movement.  The  ventricular  systole 
commences  suddenly  and  is  accompanied  with  a  considerable  diminution 
of  the  volume  of  the  organ.  Synchronoiis  with  the  systole  are  the  first 
sounds — the  impulse  of  the  apex  against  the  ribs  and  the  pulse  in  vessels 
near  the  heart;  in  the  radials  the  pulse  follows  at  a  barely  appreciable 
interval. 


ACTION  OF  THE  HEABT.  495 

The  Diastole  Motion. — The  systole  of  the  ventricles  is  followed  by 
their  diastole,  during  which  they  return,  by  an  instantaneous  expansive 
movement,  sensible  to  the  touch  and  sight,  to  the  same  state  (with  respect 
to  size,  shape,  position,  and  so  forth),  as  during  the  previous  interval  of  re- 
pose. This  movement,  or  diastole,  is  accompanied  by  the  second  soimd,  by 
an  influx  of  blood  from  the  auricle,  by  a  retractile  motion  of  this  cavity 
most  observable  at  its  sinus,  and  by  a  retrocession  of  the  apex  of  the  heart 
from  the  walls  of  the  ch«st.  Next  succeeds  the  intervals  of  repose,  dur- 
ing which  the  ventricles  remain  at  rest,  in  a  state  of  fullness  though 
not  of  distension,  through  the  whole  period  intervening  between  the 
second  and  the  first  sounds;  but  the  auricle  remains  at  rest  during  the 
first  portion  only  of  the  period,  the  remainder  being  occupied  by  its  next 
contraction,  with  which  recommences  the  series  of  actions  described. 

1.  The  ventricular  systole  occupies  half  the  time  of  a  whole  beat. 

2.  The  ventricular  diastole  occupies  one-fourth  or  one-third. 

3.  The  interval  of  ventricular  repose  occupies  one-fourth,  or  rather 
less,  during  the  latter  half  of  which  the  auricular  systole  takes  place. 

Causes  of  the  Motions. — The  auricles,  which  are  always  in  a  state  of 
fullness,  arrive,  during  the  first  half  of  the  period  of  ventricular  repose, 
at  the  state  of  distension,  by  which  they  are  stimulated  to  contract.  The 
object  of  the  contraction  at  this  movement  is  to  propel  a  small  additional 
quantity  of  blood  into  the  ventricles  for  the  purpose  of  bringing  them 
from  the  state  of  fullness  to  that  of  distension;  an  object  which  could 
not  be  accomplished  without  a  contraction,  as  the  blood  could  not  other- 
wise force  its  way  into  the  ventricles  against  the  resistance  offered  by 
their  elasticity.  The  cavities,  then,  being  brought  to  the  state  of  dis- 
tension, are  by  this  stimulated  to  contract;  they  expel  a  greater  or  less 
proportion  of  their  contents ;  in  small  animals — frogs,  for  instance — they 
expel  the  whole;  which  is  proved  by  the  ventricle  being  full.  In  larger 
animals  they  do  not  appear  to  expel  the  whole,  but  the  fact  does  not 
admit  of  demonstration.  During  the  act  of  expulsion,  the  apex  is  tilted 
up,  in  consequence  of  the  retraction  of  the  ventricles  toward  the  base 
and  upon  the  auricles,  which,  in  a  state  of  extreme  distension,  are  placed 
like  a  fulcrum  beneath  them. 

Causes  of  Diastole  Motion. — The  diastole  appears  to  be  occasioned  by 
several  concurrent  causes,  viz. : 

1.  That  power  of  the  muscle  by  which  it  reverts  from  the  state  of 
contraction  to  that  of  relaxation,  and  in  virtue  of  which  it  exercises  a 
degree  of  motion.    It  may  be  called  elasticity. 


'499  DIBEASKB  OF  THK  CIRCUI>ATORT  STSTEM. 

2.  The  distension  of  the  aiiricles,  which  is  greater  at  this  momeni 
than  at  any  other,  as  they  have  heen  filling  during  a  longer  period ; 
namely — that  of  the  ventricular  contraction,  or  half  a  whole  beat. 

3.  The  weight  of  the  ventricles  collaj)sing  on  the  distended  auricles 
underneath  them. 

4.  The  width  of  the  auricular-ventricular  orifice,  which  allows  the 
Wood  to  shoot  in  instantaneously  and  with  great  facility. 

It  is  obvious  that,  as  so  many  powerful  causes  conspire  to  promote 
the  influx  of  the  blood,  an  auricular  contraction  for  this  purpose  would 
be  superfluous.  The  escape  of  blood  from  the  aiiricles  during  the  diastole 
causes  the  slight  retraction  observable  in  them  at  the  same  moment.  The 
expelled  blood  being  instantly  replaced  from  the  vena  cava,  distension  of 
the  auricles  recommences,  and  the  same  series  of  actions  is  renewed. 

Causes  of  the  Sounds. — -The  ventricular  systole  is  the  cause  of  the 
first  sound,  by  the  impulse  which  it  communicates  to  the  blood  within  it, 
thereby  exciting  sonorous  vibrations  of  the  fluid.  If  the  sound  of  the 
muscular  contraction  contributes  at  all  to  the  first  sound  it  can  only  be 
in  a  very  slight  degree.  The  ventricular  diastole  is  the  cause  of  the 
second  sound,  by  the  reaction  of  the  walls  on  the  blood,  and  the  con- 
sequent production  of  sonorous  vibrations,  when  its  cause  is  abruptly 
arrested  by  the  completion  of  the  diastole.  Hence  this  sound  is  loud,  brief 
and  clear.  The  auricles  are  not  concerned  in  the  production  of  the 
two  sounds,  as  they  take  place  when  these  cavities  are  motionless ;  nor 
do  they  appear  to  be  productive  of  any  sound,  as  no  third  sound  is 
audible. 

Auscultation  or  Sounding. — We  now  proceed  to  examine  more  mi- 
nutely the  phenomena  produced  by  the  actions  of  the  heart,  in  health  and 
disease,  with  the  view  to  deduce  therefrom  such  diagnostic  signs  as  they 
are  capable  of  affording.  It  is  hardly  necessary  to  premise  that  the  aus- 
cultatory diagnostics  of  cardiac  diseases  are  founded  precisely  on  the  same 
principles  as  those  which  apply  to  diseases  of  the  lungs. 

GENERAL  SYMPTQMS  OF  HEART  DISEASE. 

Physical  Signs — Disturbance  of  the  functions  of  the  heart  must  neces- 
sarily produce  decided  effects  throughout  the  whole  circulatory  apparatus. 
Appreciable  modifications  of  the  arterial  pulse  of  the  state  of  the  veins 
and  capillaries  show  that  the  circulation  is  embarrassed.  The  pulse  irregii- 
lar,  unequal  and   intermittent,  as  are  the  pulsations  of  the  heart  very 


PEKICARDITIS.  497 

small;  but  when  there  is  considerable  hypertrophy  of  the  left  ventricle, 
the  pulse  is  also  hard  and  vibrating,  presenting  sometimes  a  peculiar 
fremitus,  which  is  most  distinct  in  the  carotid,  subclavian  and  radial 
arteries.  In  some  cases  the  arterial  pulsations  succeed  one  another,  stroke 
by  stroke,  and  this  reduplication  of  the  pulse  is  coincident  with  a  regurgi- 
tant murmur  heard  on  auscultating  the  heart.  The  insufficiency  of  the 
aortic  valves  is  characterized  by  a  bellows-murmur  at  the  base,  accompany- 
ing the  second  sound  of  the  heart,  and  by  a  bounding  pulse  with  flexuosity 
of  the  radial  artery. 

Symptoms. — When  disease  of  the  heart  has  reached  a  pretty  advanced 
stage,  the  existing  impediment  to  the  venous  circulation  is  indicated  by 
swelling  of  the  veins  near  the  heart ;  those,  for  example,  of  the  neck  and 
face;  and  this  turgescence  is  particularly  obvious  in  the  external  jugular 
veins,  where  it  is  sometimes  accompanied  by  undulatory  pulsations,  an- 
alagous  to  and  synchronous  with  the  arterial  pulse.  This  is  the  venous 
pulse  indicative  of  hypertrophy  of  the  right  ventricle. 

Further  Symptoms — In  addition  to  the  embarrassment  of  the  venous, 
there  is  embarrassment  of  the  capillary  circulation,  which  declares  itself 
by  a  livid  tint  of  the  'skin,  swelling  of  the  face,  j^uffiness  of  the  eyelids,  a 
bluish  color  of  the  lips,  and  more  or  less  injection  of  the  skin  of  the 
extremities. 

Palpitation — As  palpitation  is  under  all  circumstances  dependent  on 
over-excitement  of  the  nerves  of  the  heart,  the  i^henomenon  is  always  es- 
sentially the  same.  The  varieties  which  it  presents  arise  merely  from 
differences  in  the  causes  and  from  the  different  routes  which  these  causes 
pursue  in  order  to  arrive  at  and  convey  their  stimulus  to  the  heart. 

Blue  Skin — Cyanosis  is  a  morbid  appearance  which  consists  in  the 
skin  assuming  a  blue,  purple  or  violet  color,  especially  in  those  parts  Avhere 
the  cutaneous  capillary  vessels  are  superficial,  as  on  the  cheeks  and  lips. 
It  is  generally  accompanied  by  difficult  respiration,  palpitation  of  the  heart 
with  diminution  of  the  natural  temperature,  an  irregular  or  intermitting 
pulse,  and  is  often  attended  with  dropsical  symptoms,  the  face  especially, 
in  addition  to  the  purple  color,  being  bloated  and  edematous ;  all  these 
symptoms  are  much  aggravated  by  any  exertion. 

PERICARDITIS. 

Intensity  of  the  Disease. — Its  intensity  varies  considerably  in  different 
cases,  being  sometimes  excruciating  and  sometimes  slight  or  even  wanting, 
32' 


498  DISEASES    OF    THE    CIKCULATOEY    SYSTEM. 


THE  HEART 


On  the  opposite  page  will  be  found  a  diagram  of  the  heart.  This  illus- 
tration gives  a  front  view  of  the  organ  with  the  pericardium  or  sac  which  covers 
it  removed,  thus  showing  the  relative  position  of  the  heart,  lungs  and  connect- 
ing arteries.  The  thin  line  around  the  upper  part  of  the  heart  proper  and 
crossing  the  arch  of  aorta  shows  the  cut  edge  of  the  pericardium.  The  fol- 
lowing is  a  key  to  the  numbers  given  in  diagram: 

I — The  trachea  or  windpipe,  through  which  air  is  conveyed  to  the 
lungs. 
2&3 — Right  and  left  common  carotid  arteries. 

4&5 — Right  and  left  sub.  clavian  arteries.     The  right  arises  from  the 
innominate  artery,  as   shown   in   figure  6,  and  the  leTt  from 
the  aorta  at  the  termination  of  the  arch. 
6 — Innominate  artery.     The  origin  of  this  artery  is  the  arch  of  the 
aorta,   and   subdivides   into   the   right    sub.    clavian    and    the 
right  common  carotid  arteries. 
7&8 — Right  and  left  innominate  veins  or  nameless  veins.    These  veins 
unite   to    form   the   superior   vena   cava. 
9 — Superior  vena  cava  or  superior  hollow  vein.    Through  this  trans- 
mission of  blood   is   made   to   the  heart   from  the   head  and 
neck. 
ID — Arch  of  the  aorta.    The  curved  parts  between  the  ascending  and 

descending  portions   of   the    aorta. 
II — Ascending  aorta  or  the  large  arterial  trunk  arising  from  the  left 
ventricle  of  the  heart  and  giving  origin  to  every  artery  ex- 
cept  the   pulmonary   and   its   branches. 
12 — The   pulmonary  artery.     The  branches  of   this   artery   supply  all 

parts  of  the   lungs. 
13 — Right  atrium   and  auricula. 
14  &  15 — Right  and  left  lung.     In  the  drawing  they  are  laid  back,  exposing 
the  position  of  the  heart  and  the  various  arteries  and  veins. 
The  air  passing  through  the  small  air  vessels  oxygenate  or 
purify   the   blood,   a   most   necessary   function   in    all   warm- 
blooded  animals.     The   seat  of  the   much-dreaded   and  fatal 
disease.   Pulmonary   Tuberculosis,   is   in   the   lungs. 
16 — Conus  Arteriosus.    The  upper  angle  of  the  ventricle  is  prolonged 

into  a  conical  pouch  termed  the  Conus  Arteriosus. 
17 — The    right   ventricle   or   cavity   in    the    heart    for   the    pulmonary 

circulation. 
iS— The   left  ventricle   for   the   general   or   systemic   circulation. 


DISEASES  OF  THE  CIKCULATOKY  SYSTEM. 


499 


THE  HEART 

For  an  explanation  of  this  illustration  see  text  on  opposite  page 


500  DISKASKS   OK    TJIE    CI  Itc;  UI-ATORY    SYSTEM. 

There  is  also  more  or  less  tenderness  on  pressure  over  the  region  of  the 
heart,  and  its  action  is  notably  increased.  With  these  local  symptoms  are 
associated  those  pertaining  to  the  system  at  large  which  accompany  symp- 
tomatic fever.  As  the  afPection  is  almost  always  developed  in  connection 
with  other  diseases,  the  symptoms  of  the  latter  are  of  course  combined  with 
those  of  the  former. 

Diagnosis. — The  diagnosis  or  recognition  of  pericarditis  has  been  ren- 
dered prompt  and  positive  by  means  of  auscultation  and  pei'cussion.  Soon 
after  the  attack  the  exudation  of  fibrine  occasions  a  friction  sound  with  the 
heart's  movements,  and  this  is  proof  of  the  existence  of  the  disease. 
Afterward,  when  considerable  liquid  has  been  eifused  into  the  sac,  the 
friction  sound  may  cease,  but  it  is  practicable  to  determine  the  presence 
and  the  quantity  of  liquid  withiii  the  sac  by  physical  signs,  which  are 
obtained  only  by  auscultation  and  percussion.  The  danger  in  cases  of 
pericarditis  depends,  other  things  being  equal,  on  the  intensity  of  the 
inflammation,  the  quantity  of  exuded  fibrine  and  the  amount  of  effused 
fluid.  Aside  from  these  conditions,  much  depends  on  the  diseases  with 
which  it  is  associated. 

Symptoms. — When  developed  in  connection  with  rheumatism,  it  ends 
in  recovery  in  the  majority  of  cases;  but  occurring  in  connection  with 
diseases  of  the  kidneys,  with  pleurisy  or  pneumonia,  and  in  cases  of 
pyemia,  it  ends  in  death  much  oftener  than  in  recovery.  ^Mien  death  is 
not  sudden,  the  disease  destroys  life  by  slow  asthenia  or  exhauslion. 

As  a  rule  from  the  outset  we  have  acute  inflammatory  fever,  a 
pungent,  burning,  lancinating  pain  in  the  region  of  the  heart,  shooting  to 
the  left  scapula,  shoulder,  and  upper  arm,  but  rarely  descending  below 
the  elbow,  or  even  quite  to  it.  The  pain  is  increased  by  full  inspiration, 
by  stretching  the  left  side,  and  especially  by  pressure  between  the  pre- 
cardial  ribs,  and  by  forcing  the  epigastrium  upward  underneath  the  left 
hypochondrium.  WTien  the  inflammation  is  only  subacute  the  pain  is 
more  or  less  dull,  and  does  not  lancinate.  There  is  inability  of  lying  on 
the  left  side,  and  sometimes  In  any  position  but  one,  which  is  most  com- 
monly on  the  hack,  dry  cough,  hurried  respiration,  palpitation  of  the 
heart,  the  impulse  of  which  is  sometimes  violent,  boimding  and  regular, 
though  its  heats  may  at  the  same  time  be  unequal  in  strength,  at  other 
times  it  Is  feeble,  fluttering  and  irregular,  pulse  always  frequent,  and  gen- 
erally, at  the  outset,  full,  hard,  jerking  and  often  with  a  thrill. 

Causes. — The  most  frequent  caiises  are  blows  or  excessive  pressure 
in   the  pericardial  region,   inflammation  propagated  from  the  lungs  or 


PBBIOABDITISo  601 

pleura,  and  far  above  all,  rheumatism.  From  this  cause  children  and 
young  persons  suffer  much  oftener  than  others.  The  remaining  causes 
are  those  of  inflammation  in  general,  viz.,  cold,  febrile  excitement,  and  so 
forth. 

Treatment.- — As  regards  treatment,  acute  pericarditis  claims  in  gen- 
eral the  measures  indicated  in  other  inflammatory  affections.  The  anti- 
phlogistic treatment,  in  as  energetic  a  form  as  circumstances  will  allow, 
should  be  employed  with  the  utmost  promjititude.  The  loss  of  a  few  hours 
at  first  may  be  irretrievable,  and  hence  hesitation  and  indecision  may  seal 
the  fate  of  the  jjatient.  These  measures,  however,  are  in  many  cases  to 
be  modified  by  the  circumstances  pertaining  to  the  diseases  with  which 
this  is  associated. 

Strength  of  tlie  Remedies. — The  strength  of  the  remedies  employed 
must  in  each  case  be  apportioned  to  the  vigor  of  the  patient's  constitution ; 
but  the  object  is  the  same  in  all,  expeditiously  to  prostrate  the  action  of 
the  heart,  and  for  a  time  to  keep  it  prostrate  by  preventing  the  re-estab- 
lishment of  reaction.  If  this  object  can  be  accomplished  for  the  first 
twenty,  thirty  or  forty  hours,  the  disease  frequently  does  not  rally,  but 
remains  perfectly  under  the  control  of  remedies. 

Additional  Treatment. — In  addition  to  the  above  measures  diluent 
cooling  drinks — as  four  scruples  of  bitartrate,  or  two  of  nitrate  of  potassa 
in  a  quart  of  water,  and  flavored  at  pleasure — should  be  allowed  in  un- 
limited quantity,  in  order  by  diluting  the  blood  to  render  it  less  stimulant 
to  the  heart.  ISTauseating  doses  of  tartrate  of  antimony,  as  one-sixth  to 
one-eighth  of  a  grain  every  two  hours,  may  be  employed  with  advantage. 
Colchicum  often  proves  useful,  especially  so  when  the  disease  is  of  rheu- 
matic origin.  Calomel,  trusted  still  by  some  and  abused  by  others,  may 
be  confined  to  open  asthenic  cases  in  previously  good  constitutions.  Where 
the  rheumatic  diathesis  is  marked,  alkalies  will  ]>v  indicated.  Carbonate 
or  bicarbonate  of  potassium,  or  birarbonate  of  sodium,  may  bo  given  in 
scruple  or  half  doses,  with  as  much  of  rochelle  salts,  three  or  four  times 
a  day. 

Continued  Treatment. — Should  pain  continue  in  the  advanced  stages 
of  the  disease,  blisters  may  be  resorted  to,  and  repeated  in  quick  succes- 
sion, with  great  advantage.  For  the  stage  of  effusion  we  have  occasion- 
ally found  a  third  or  a  fourth  necessary,  condiiiied  willi  the  use  of  diur- 
etics, as  squills,  juniper,  sps.  ether,  nit.,  and  so  forth,  varied  and  cdu- 
tiuiiod  mitil  absorjitioii  occurs.     Tonics  will  often  ])roniote  the  same  end. 

Convalescence — An  individual  who  has  recently  been  affected  with 
pericarditis  is  peculiarly  liable  to  a  recurrence  of  it,  especially  if  it  has 


502 


DISEASES  OF  THE  CIECUIATOEY  SYSTEM. 


resulted  from  rheumatism,  and  if  the  reparation  has  heen  incomplete. 
In  this  case,  should  rheumatism  return,  it  rarely  fails  to  be  accompanied 
with  a  renovation  of  the  pericarditic  symptoms. 

Diet. — A  very  spare  unstimulating  diet  and  extreme  tranquillity  must 
be  imperatively  enjoined  until  the  action  of  the  heart  has  become  per- 
fectly and  permanently  natural.  This  should  consist  wholly  of  the  weak- 
est slops,  as  barley,  water  gruel,  weak  tea,  arrow  root,  and  so  forth. 

Chronic  Pericarditis. — Chronic  pericarditis  may  be  a  sequel  of  the 
acute  affection,  or  the  inflammation  may  be  subacute  from  the  first.  In 
some  cases  the  inflammation  continues  with  an  abundant  exudation  of 
lymph,  agglutinating  the  in- 
ner surfaces  of  the  sac,  and 
proving  fatal  by  slow  ex- 
haustion. In  other  cases  a 
large  accumulation  of  liquid 
takes  place,  amounting  to 
several  pounds  in  weight, 
and  to  the  exhaustion  inci- 
dent to  the  persistance  of 
the  inflammation  is  added 
the  compression  of  the  heart 
thus  occasioned.  In  both 
varieties  of  the  disease,  as 
a  rule,  proves  fatal  sooner 
or  later. 

Treatment  of  Chronic 
Pericarditis — A  rapidly  de- 
pressing case  of  pericard- 
itis, with  cold,  blue  skin 
and  feeble,  irregular  pulse, 
will  require,  instead  of  the 
above,  a  supporting  or  stim- 
ulating treatment  from  the 

first;  with  dry  cups  and  blisters  instead  of  local  or  general  bleeding;  and 
quinine,  ammonia  and  whiskey,  instead  of  sudorifics  or  laxatives. 


Cavities  of  Right  Side   of  Heart,   with   tlieir   Valves. 


ENDOCAKDITIS. 

Signs  of  the  Disease. — Inflammation  of  the  internal  membrane  of  the 
heart.     In  this  affection  the  inflamed  membrane  is  in  contact  with  the 


ENBOCAEDITIS.  503 

blood  contained  within  the  cavities  of  the  heart ;  hence,  although  fibrinous 
exudation  takes  place  as  in  pericarditis,  the  exuded  lymph  is  in  a  great 
measure  washed  away  from  the  membrane  and  carried  into  the  circula- 
tion. A  portion,  however,  adheres  to  the  membrane,  roughening  the  sur- 
face in  contact  with  the  blood,  and  giving  rise  to  an  abnormal  sound  (an 
endocardial  or  bellows  murmur),  which  is  an  important  physical  sign  of 
the  disease.  Moreover,  upon  the  little  masses  of  lymph  which  adhere  to 
the  membrane,  coagulated  fibrine  from  the  blood  contained  in  the  cav- 
ities of  the  heart  is  apt  to  be  deposited,  and  in  this  way  are  produced  the 
so-called  vegetations  or  warty  growths,  which  being  sometimes  detached 
and  carried  into  the  arteries  with  the  current  of  the  blood,  are  arrested 
in  vessels  too  small  to  allow  of  their  further  progress,  become  fixed  and 
occasion  an  obstruction  which  may  lead  to  hemorrhage  (hemorrhagic  in- 
farctions), and  to  the  impairment  of  nutrition  within  a  circumscribed 
area  beyond  the  point  at  which  the  obstruction  is  seated.  These  movable 
plugs  or  emboli,  as  they  are  termed,  play  an  important  part  in  afl^ectiona 
proceeding  from  disturbance  of  the  circulation  and  nutrition  in  different 
organs  of  the  body,  more  especially  the  brain. 

local  Effects.- — The  local  effects  of  endocarditis  are  also  of  much  im- 
portance as  laying  the  foundation  for  progressive  changes,  especially  in 
the  valves  of  the  heart,  constituting  what  are  called  valvular  lesions. 
The  inflammation  in  endocarditis  is  generally  limited  to  the  left  side  of 
the  heart;  that  is,  to  the  endocardial  membrane  lining  the  left  ventricle_ 
and  the  left  auricle. 

Causes. — Like  pericarditis,  this  is  very  rarely  a  primary  disease,  and 
in  the  great  majority  of  cases  it  occurs  in  connection  with  acute  articular 
rheumatism.  It  is  evidently  due  to  the  same  internal  agency  which  in 
rheumatism  causes  the  inflammation  within  the  joints;  this  agent,  being 
a  morbid  principle  in  the  blood,  is  supposed  to  be  lactic  acid. 

Diagnosis, — Its  develojsment  is  attended  with  little  or  no  pain  or  other 
subjective  symptoms  referable  to  the  heart;  the  diagnosis  rests  wholly 
upon  physical  evidence  attained  by  auscultation.  The  roughening  of  the 
endocardial  membrane  within  the  left  ventricle  causes,  as  already  stated, 
an  adventitious  sound  or  murmur,  and  the  production  of  this  murmur, 
while  a  patient  is  under  observation,  constitutes  the  proof  of  the  presence 
of  the  affection. 

Symptoms — The  symptoms  produced  are  blueness  and  coldness  of 
the  skin,  the  result  of  the  disease  affecting  the  valves  of  the  heart  so  as 
to  render  them  more  or  less  incompetent  to  perform  their  functions,  and 


604  DISEASES  OF  THE  CIRCULATORY  SYSTEM. 


HUMAN    INTERNAL    ORGANS. 


THE  ITJNGS. 

Upper  Left-Hand  Plate. — This  handsome  plate  shows,  at  the  top,  the  windpipe 
(trachea)  entering  the  lungs.  It  divides  into  two  branches,  one  for  each  lung,  and 
each  branch  subdivides,  so  as  to  carry  air  to  every  part  of  the  lung. 

Lobes. — The  plate  shows  the  two  great  parts  of  the  lungs,  right  and  left  lobes. 
These  are  filled  with  the  air  cells.  Notice  in  the  lobes  the  immense  number  of 
veins  which  form  the  circulatory  system  of  the  lungs. 

Heart. — The  heart  is  seen  in  its  true  position,  to  the  right  of  the  centre. 

Pulmonary  Vein. — To  the  left  of  the  centre  is  seen  the  great  pulmonary  vein, 
carrying  the  lung-blood  to  the  left  auricle  of  the  heart. 

Pleura. — The  pleura  niembrano  is  seen  surrounding  the  entire  lungs  and  wall- 
ing them  in. 

THE   LIVER. 

Upper  Right-Hand  Plate. — The  liver  is  the  largest  gland  in  the  body.  Situated 
on  the  right  side,  and  partly  covers  the  stomach. 

Lobes. — The  plate  shows  its  two  lobes  on  upper  surface  and  five  on  under 
surface. 

Vessels. — The  entire  circulatory  system  is  shown — portal  vein,  hepatic  artery, 
hepatic  duct,  lymphatic  and  smaller  veins.  To  the  left,  in  pear-shape,  is  the 
gall   bladder. 

THE  HEART. 

Lower  Left-Hand  Plate. — The  plate  shows  the  cone-shaped  heart,  situate  in 
the  cliest,  between  the  lungs,  its  apex  toward  the  left.  Though  supplying  blood  to 
the  whole  body,  it  yet  has  its  own  circulation,  as  seen  by  its  veins. 

Cavities. — It  has  four  cavities,  an  auricle  and  ventricle  on  each  side.  The  right 
auriile  receives  the  venous  blood  and  pumps  it  into  the  right  ventricle.  The  right 
ventricle  throws  its  blood  into  the  left  auricle.  The  left  ventricle  pumps  it  into 
the  aorta  and  thence  through  the  body.  The  upper  section  of  the  plate  shows  the 
aorta  and  the  great  pulmonary  vein. 

THE  STOMACH. 

Lower  Right-Hand  Plate. — The  plate  shows  the  stomach  when  one  is  in  a  re- 
clining  position. 

Veins. — The   numerous  veins   show   how   well   it   is  nourished. 

Li'c'er. — To  the  left  is  the  liver.  Above  it  is  the  opening  through  which  food 
passes  from  the  gullet  (oesophagus).  At  the  opposite  end  is  tbe  pyloric  gate, 
through  \xhich  the  partly  digested  food  passes  into  the  duodenum  (twelve-mch 
bowel). 

Muscles. — .^round  the  stomach,  in  brown  and  white,  are  seen  the  powerful 
abdominal  nuiscles.  The  white  represents  streaks  of  fatty  matter.  The  stomach 
is  usually  about   twelve   inches  long  and    four   inches   in   diameter 


Lungs  &  ffedrtin  Position 


Section  of  liver 


The  fieart  S/iowingThe  Great Arfens.      TheStomdcfi  -  /rout  view  rigure/n  Rec/ining Position 

/fumdn  Interna/  organs. 


COPYRUSHT    19  IG    OV  E  ,  J   STANLEY 


ENDOCAEDITIS.  505 

diminisliiiig  the  size  of  the  mitral  or  aortic  orifice  so  as  to  produce  more  or 
less  obstruction  to  the  passage  of  blood.  Obstruction  of  the  flow  of  blood 
through  the  orifices  within  the  heart,  and  regurgitation,  lead  to  enlarge- 
ment of  the  organ  and  to  various  morbid  effects  in  other  organs;  indis- 
tinctness of  the  heart  sound,  feebleness  and  irregularity  of  the  pulse, 
nausea  and  vomiting,  anxiety  of  expression  and  fainting. 

Treatment — In  every  case  the  important  question  is,  less  the  state 
of  the  particular  valves  than  the  amount  of  interference  with  the  func- 
tional action  of  the  heart.  In  young  persons  remarkable  recoveries  some- 
times take  i^lace.  In  other  instances,  adaptation  of  the  heart  itself,  and 
of  the  general  system  by  degrees,  is  effected,  so  that  quite  good  health,  and 
even  capacity  for  exercise,  niay  be  attained,  while  the  physical  signs  of  the 
local  organic  change  remain.  Sudden  death  is  less  common  in  heart  dis- 
ease than  is  pojiularly  supposed. 

The  Circulation — The  circulation  should  be  kept  as  tranquil  as  pos- 
sible by  a  quiet  life  and  a  moderate  imstimulatihg  diet.  The  food,  how- 
ever, should  be  rather  nutritious,  comprising  a  little  animal  food  or  soup 
twice  a  day,  in  order  to  keep  the  muscular  system  in  general,  and  that  of 
the  heart  in  particular,  in  tone.  The  same  may  be  promoted  by  a  clear, 
bracing,  dry  air.  The  general  health  and  strength  may  likewise  be  im- 
proved by  the  occasional  exhibition  of  bitters,  mineral  acid  and  chaly- 
beates,  with  aromatics.  The  stomach,  in  particular,  should  be  kept  in 
good  order,  as  its  derangements,  even  a  little  flatulence  or  acidity,  have  a 
surprising  effect  in  disturbing  the  action  of  the  heart.  The  same  may  be 
said  of  the  biliary  secretion,  when  there  is  an  unequal  distribution  of 
venous  power,  indicated  by  hysterical  symptoms,  and  so  forth,  antispas- 
modics will  be  found  useful. 

Value  of  a  Bath. — Attacks  of  dyspnoea  are  best  relieved  by  immers- 
ing all  the  extremities  in  warm  water,  a  blanket  being  thrown  around  the 
patient  to  promote  perspiration,  and  fresh,  cool  air  being  admitted  to 
satisfy  the  craving  for  breath.  While  this  is  being  done  he  should  take 
an  antispasmodic  draught,  composed  of  either  laudanum,  camphor,  am- 
monia, and  asafetida,  combined  according  to  circumstances.  It  may  be 
repeated  two  or  three  times,  at  intervals  of  from  half  an  hour  to  an  hour, 
according  to  circumstances. 

Diet. — For  the  avoidance  of  attacks  the  more  important  of  the  meas- 
ures of  management  relate  to  a  proper  regulation  of  the  habits  of  life  as 
regards  diet,  exercise  and  so  forth.  While  excessive  muscular  exercise 
is  to  be  avoided,  such  an  amount  as  is  taken,  without  discomfort,  may  bs 


506  DISEASES  OF  THE  CIECULATOEY  SYSTEM. 

highly  useful  by  improving  the  general  condition  of  the  system ;  while 
excesses  in  eating  and  drinking  are  hurtful,  a  deficient  alimentation  is  not 
less  so.  In  brief,  the  great  end  of  treatment  is  to  render  the  system 
tolerant  of  the  lesions  as  much  and  as  long  as  possible,  and  this  end  is 
promoted  by  such  a  course  of  management,  hygienic  and  medicinal,  as 
conduces  to  the  general  welfare  of  the  economy. 

ADDISON'S  DISEASE. 

Nature. — Certain  forms  of  general  anemia  which  are  neither  attri- 
butable to  excessive  antecedent  hemorrhages,  nor  to  profuse  or  long  con- 
tinued intestinal  fluxes,  and  which  cannot  by  symptoms  be  connected  with 
any  diathesic  state  or  marsh  miasmatic  influences,  forms  of  general 
anemia,  in  fact,  which  appear  to' supervene  under  the  influence  of  non- 
recognizable  causes,  in  which  besides  the  debility  and  languor  of  the  pa- 
tient, are  characterized  by  a  bronzed  hue  of  the  integuments,  and  which 
is  most  strikingly  apparent  on  the  skin  of  the  hands,  penis,  groin,  scrotum 
and  axilla. 

It  has  been  termed  by  Addison  the  bronzed  disease. 

Symptoms — The  malady  begins  slowly,  and  its  existence  is  not  at 
first  perceived.  The  patient  has  difficulty  in  fixing  with  precision  the 
date  at  which  he  experienced  its  earliest  symptoms.  Its  first  manifesta- 
tions are  general  discomfort,  an  enfeebling  of  the  physical  and  moral 
faculties,  and  a  state  of  real  languor.  The  arterial  pulsations  are  small 
and  feeble,  the  pulse  full,  soft  and  easily  compressed.  The  appetite  is 
capricious,  the  patient  showing  repugnance  to  animal  food,  or  a  dimin- 
ished appetite.  At  first  digestion  proceeds  in  a  normal  manner ;  at  a  later 
stage  this  function  is  disturbed  by  intractable  vomiting.  This  symptom 
is  accompanied  by  pain,  or  at  least  by  a  painful  sensation  in  the  epigastric 
region.  The  patient  wastes  away,  and  yet  the  most  minute  examination 
fails  to  discover  any  sign  of  organic  change  sufficient  to  account  for  the 
great  disturbance  of  health  and  extreme  anemia  which  exist.  Finally 
there  is  a  state  of  extreme  debility. 

Treatment. — In  the  treatment,  having  no  specific  remedy,  we  are 
obliged  to  direct  our  measures  against  the  symptoms  of  anemia ;  ferrugi- 
nous medicines,  preparations  of  cinchona,  and  a  tonic  regimen  are  indi- 
cated. Decided  advantage  has  followed  the  use  of  a  combination  of 
glycerine,  in  two-drachm  doses,  with  fifteen  or  twenty  minims  each  of 
chloroform  and  tincture  of  chloride  of  iron. 


QOITEE.  507 

OBSTRUCTION  OR  OCCLUSION  OF  THE  ARTERIES 

EMBOLISM. 

Symptoms. — When  the  right  half  of  the  heart  has  received  an  em- 
bolus and  the  pulmonary  artery  is  obstructed,  collapse  o£  the  lungs,  partial 
or  entire,  follows.  Pleurisy,  hemorrhage  or  bronchitis  may  also  occur, 
or  the  symptoms  may  be  great  anxiety  and  dyspnoea,  with  reduction  of 
the  temperature  of  the  body,  a  systolic  murmur  may  be  heard  on  ausculta- 
tion; the  rhythm  of  the  heart  becomes  irregular,  and  pulsation  of  the 
jugular  veins  may  be  noticed.  Giddiness  may  be  present,  with  blueness 
and  edema  of  the  hands,  feet,  or  both.  Where  emboli  have  become 
broken  up  and  decomposed,  septicemia  results,  commonly  known  as 
pyemia. 

Treatment. — The  objects  we  should  have  in  view  in  the  treatment  of 
a  vessel  occluded  by  an  embolus  are,  to  favor  the  venous  circulation 
through  the  limb  by  its  elevation,  and  to  establish  the  arterial  collateral 
circulation  by  maintaining  the  warmth  of  the  limb  by  means  of  cotton 
carefully  wrapped  round  it  over  oil  lint.  Pain  can  be  relieved  by  seda- 
tives, while  the  powers  of  the  patient  are  to  be  maintained  by  nutritious 
diet,  by  stimulants  carefully  administered  and  by  tonics.  When  gangrene 
has  taken  place  the  parts  may  be  covered  with  some  antiseptic  material, 
as  carbolic  acid  in  a  watery  or  oily  solution,  one  part  to  thirty,  or  with 
powdered  chloral.  When  the  line  of  demarcation  has  formed  and  the 
gangrenous  part  can  be  removed  by  amputation,  such  an  operation  may  be 
performed. 

GOITRE  (GRAVE'S  DISEASE). 

Goitre  may  be  simple  or  exopthalmic.  Simple  goitre  is  a  local  affec- 
tion with  only  symptoms  such  as  dyspncea,  or  the  cough  as  of  a  broken- 
winded  horse  and  difficulty  in  breathing  on  slight  exertion.  Exopthalmic 
goitre  is  a  disease  of  the  nervous  system  characterized  by  protrusion  of 
the  eyeballs,  enlargement  of  the  thyroid  gland  and  palpitation  of  the  heart, 
a  peculiar  thrill  in  the  blood-vessels  and  a  general  deterioration  in  muscular 
and  brain  power.  The  veins  and  arteries  of  the  thyroid  glands  are  en- 
larged. As  a  rule  the  development  of  the  disease  is  gradual.  The  goitre  is 
elastic  and  rather  soft.  The  protrusion  of  the  eyeballs  follows  the  swelling 
of  the  gland.     The  disease  is  more  common  with  women  than  with  men. 


50S  DISEASES  OF   THE   CIIICIJ  r,AI()KY   SYSTEM. 

Recovery  occurs  in  a  fair  miiiibpr  of  cases,  Imt  the  course  is  slow.  Although 
occasionally  sporadic,  it  is  essentially  an  endemic  disease  in  cold  and  damp 
countries,  as  in  the  deep  valleys  of  the  Alps,  the  Pyrenees,  the  North 
American  Rockies,  the  Cordilleras  of  South  America,  and  the  chalky 
districts  of  Derbyshire,  England. 

Treatment. — Simple  goitres  are  to  be  treated  on  ordinary  principles, 
viz.,  by  attention  to  the  general  health,  the  inhalation  of  fresh  air  and  by 
tonic  medicines.  Filtered  or  distilled  water  should  always  be  taken,  moro 
particularly  in  districts  where  chalk,  lime  and  magnesia  abound.  Iodine 
has  always  been  held  in  high  repute  in  this  disease,  in  the  form  of  com- 
pound solution  of  iodine,  tbree  drops  in  a  glass  of  milk,  three  times 
a  day.  For  some  years  we  have  employed  tonics  alone  by  the  mouth, 
and  have  ordered  the  air  in  the  room  to  be  kept  iodized  by  means  of 
solid  iodine  put  into  a  box  with  a  perforated  lid ;  the  metal  thus  evapo- 
rates steadily  into  the  room  wlicre  the  patient  sits  and  sleeps,  and  in  this 
way  it  becomes  absorbed. 

ANEURISM  OR  BLOODY  TUMOR. 

Causes — A  low  form  of  iuflnmination  of  the  arterial  walls  is  with- 
jut  doul)t  the  most  common  predisjtosing  cause,  while  over-action  of  tlie 
heart  and  circulation  is  the  exciting  one.  Direct  injury  to  an  artery 
(traumatic)  is  an  occasional  cause.  s# 

Symptoms. — Tlie  early  symptoms  of  aneurism  are  very  uncertain. 
It  often  happens  that  the  patient's  attention  is  first  directed  to  some  swell- 
ing-, although  it  mav  be  only  that  of  local  throbbing,  some  weakness  or 
stiffness  of  an  exti-emity,  or  some  nerve  pain  preceding  the  discovery  of 
the  disease ;  yet  such  symptoms  are  not  constant.  When,  however,  you 
are  consulted  for  pain  which  shoots  dovsm  the  course  of  a  nerve  running 
in  contact  with  a  large  artery,  you  should  allow  the  thought  of  aneurismal 
pressure  to  pass  through  your  mind,  and,  when  this  is  associated  with  the 
presence  of  a  tumor  connected  with  the  vessels,  the  suspicion  of  its  being 
aneurismal  should  be  excited.  If  this  timior  be  soft  and  pulsating,  and 
becomes  tense  on  the  application  of  pressure  to  the  trunk  of  the  artery  on 
the  distal  side,  and  placid,  non-pulsatile  and  vanishing  on  pressure  in  the 
vessel  below,  the  chances  of  its  being  aneurismal  amount  almost  to  a 
certainty.  Should  it  expand  again  readily  on  the  removal  of  pressure, 
this  expansion  is  accompanied  with  a  peculiar  thrill  on  the  readmission 


PHLEBITDS   OE  INlflAilMATlON   OF   THE   VEIKS.  SO^ 

of  blood  into  the  sac,  with  a  bellows  murmur  or  aneurismal  bruit,  svucbro- 
nous  with  the  pulse. 

Treatment. — The  spontaneous  cure  of  an  aneurism  is  caused  by  the 
coagulation  of  the  blood  in  the  sac;  how  to  induce  this  coagulation  by 
natural  processes  is  our  aim ;  therefore,  it  is  necessary  to  have  a  feeble  cir- 
culation through  it ;  for  this  purpose,  rest  in  the  recumbent  position  is  an 
essential  point  of  practice,  and  shoidd  be  maintained  in  every  case.  When 
the  force  of  the  circulation  is  too  strong  and  the  powers  of  the  patient  are 
good,  bleeding  under  this  circumstances  is  not  only  rational  but  scien- 
tific. Medicines  do  not  seem  to  have  much  influence  in  the  coagulating 
process,  though  the  acetate  of  lead  has  been  found  useful  and  iodide  of 
potassium.  The  local  treatment  is  based  on  similar  principles,  the  aim 
being  to  diminish  the  circulation  through  the  sac.  This  may  be  effected 
by  the  following  means,  viz.,  by  compression  in  one  of  its  forms  of  the 
artery  above  the  aneurism,  indirect;  by  compression  of  the  aneurism 
itself,  direct;  by  the  Hunterian  oiJeration,  viz.,  the  application  of  a  liga- 
ture to  the  artery  on  its  cardiac  side ;  by  imitating  the  rare  natural  process 
of  closiire  of  the  artery  on  its  distal  side  by  the  application  of  a  ligature, 
or  by  pressure,  or  by  the  artificial  production  of  an  embolic  plug,,  by 
Fergusson's  method  of  manipulation,  and  last  of  all  it  may  lit  laid  opeu 
and  both  ends  tied.  The  treatment  by  electro-puncture,  injection,  and  the 
introduction  of  some  foreign  body  into  the  sac  may  be  adopted  in  excep- 
tional cases.  V 

PHLEBITIS  OR  INFLAMMATION  OF  THE  VEINS. 

Symptoms. — The  most  prominent  symptom  of  an  obstructed  vein  is 
edema  of  the  parts  below  the  obstruction,  some  fullness  of  the  superficial 
veins,  local  pain  and  tenderness ;  constitutional  disturbance  of  variable 
degrees  of  severity  generally  preceding.  When  superficial  veins  are  in- 
volved the  symptoms  may  be  chiefly  local,  but  in  the  case  of  deep  veins 
constitutional  disturbance  is  certain  to  accompany  local  action.  Among 
the  superficial  veins  the  saphena  of  tlie  leg  and  thigh  is  most  commonly 
affected,  and  is  often  a  sequelae  of  a  varicose  condition.  Under  these  cir- 
cumstances the  tortuous,  dilated,  indurated  vein  becomes  a  marked  object, 
set  as  it  were  in  a  frame  of  hardened  inflamed  skin  and  a  cellular  tissue. 

Treatment.— The  two  great  indications  for  treatment  in  these  cases 
are  to  favor  venous  circulation  of  the  part,  and  to  improve  the  general 
condition  of  the  patient. 


510 


DISEASES  OF  THE   CIECni.ATORT   SYSTEM. 


THT]    ARTERIES 


Figure   No.   i. — Arteries  of  the  palm 
of  the  hand  and   front  of  forearm. 

3.  Deep  part  of  the  raised  pronator 

of  the  radius. 

4.  Long  supinator  muscle. 

5.  Long  flexor  of  the  thumb. 

6.  Square  pronator. 

7.  Deep  flexor  of  the  fingers. 

8.  Cubital  flexor  of  the  wrist. 

9.  Annular  ligament,  with  the  ten- 

dons that  pass  under  the  centre 
of  the  palm  of  the  hand ;  the 
member  is  on  the  tendon  of  the 
long  palmary  muscle  divided 
near  its  insertion. 
10.  The  brachial  artery. 

12.  Radial  artery. 

13.  Recurring    radial    artery    joining 

the  end  of  the  upper  deep  one. 

14.  Superficial  veins. 

15.  Cubital  artery. 

16.  Superficial     palmary     arch     from 

which  spring  digital  branches  to 
three   and   one-half  fingers. 

17.  Magna  artery  of  the  thumb  and 

radial  artery  of  the  index. 

18.  Back  cubital  recurring  artery. 

19.  Front   interosseous   artery. 

20.  Back  interosseous  artery  passing 

through   the  interosseous   mem- 
brane. 

Figure  No.  2. 

I.  Primitive  carotid  artery  dividing 
itself  into  carotid  external  and 
carotid  internal. 

3.  Occipital  branch  to  the  back  part 

of  the  skull. 

4.  Upper  hyoides  artery. 

5.  Lower  pharyngeal  artery. 

6.  Masseter  artery. 

7.  Submental  artery. 

8.  Lower  coronary  artery. 

9.  Upper  coronary  artery. 

10.  Deep  branch. 

11.  Back  cervical  artery. 

12.  Continuation  and  fold  of  the  oc- 

cipital. 

13.  Descending   branch    for    muscies 

of  the  neck. 

14.  Posterior  auricular. 

15.  15.  Temporal  artery. 

16.  Parietal  branches. 


17.  Frontal  branches. 

19.  Orbitary  branches. 

20.  Subclavian  artery. 

Figure  No.  3. 

Thoracic  aorta. 

The  three  branches  from  left  to  right 
are  the  unnamed  ones. 

The  primitive  left  carotid  and  the  sub- 
clavian  left  one. 

The  small  branch  in  the  curve  is  the 
bronchial  one. 

Figure  No.  4. 

1.  The  liver. 

2.  The  stomach. 

3.  Upper  gut 

4.  Pancreas. 

6.  Great  mesenteric  artery. 

7.  Gastric  branch. 

8.  Spleen. 

9.  Pyloric  branch. 

10.  Pancreatic  branch. 

11.  Hepatic   artery. 

12.  Duodenal  branch. 

13.  Cystic  artery. 

14.  Branches  to  the   stomach. 
IS,  16.  Spleenic  arteries 

17.  Gastro-epiploic  artery. 

18.  Descending  aorta. 

19.  Great  mesenteric  artery. 

Figure  No.  5. 

1.  Cheek  arteries. 

2.  Coeliac  axis. 

3.  Gastric   artery. 

4.  Hepatic  artery  dividing  itself  into 

right  and  left  branches. 

5.  Spleenic  artery. 

6.  Supra-renal  artery  on  right  side. 

7.  Right     renal     artery,     which     is 

longer  than  the  left. 

8.  Lumbar  arteries. 

9.  Upper  mesenteric  artery. 

10.  The  two  spermatic  arteries. 

11.  The  lower  mesenteric. 

12.  The  middle  sacras. 

13.  The  common  iliac. 

14.  Internal  iliac  of  the  right  side. 

15.  External  iliac. 

16.  Epigastric  artery. 

17.  Circumflex  iliac  artery. 

18.  Femoral  artery. 


Fisure  No.  I. 


Fiffure  No.  2. 


Fiffure  No.  4. 


Ficure  No.   S 


THE   ARTERIES. 

for  an  ezpUnatloa  of  the  iUustratioiiB  see  text  uu  upputdle 

511 


512  DISEASES  OF  TUE  CIECULATORY  SYSTEM. 

Tke  first  is  attained  by  elevation  of  the  limb,  the  foot  being  raised 
liighcr  tlian  the  hip,  and  by  the  application  of  -warmth.  The  second  can 
be  carried  out  by  the  administration  of  a  simjjle  nutritious  diet,  tonics, 
such  as  quinine,  bark  or  iron,  and  stimulants  carefully  adjusted  to  the 
wants  of  the  individual  case. 

Pain  must  be  allayed  by  both  local  and  general  means,  as  poppy 
fomentations,  and  the  internal  use  of  sedatives.  Leeching  should  never 
be  resorted  to,  nor  the  use  of  mercury.  When  suppuration  appears  it 
must  be.  dealt  with  on  ordinary  principles,  but  it  is  well,  as  a  rule,  to 
evacuate  it  as  soon  as  it  has  declared  itself. 

»       INFLAMMATION  OF  THE  LYMPHATIC  VESSELS  AND  GLANDS. 

Symptoms. — 1.  The  absorbent  glands  with  their  ducts  are  liable  to  in' 
flamniation,  adenitis  or  angeioleucitis,  and  this  action  is  the  result  of  the 
absorption  of  some  septic  material.  It  is  almost  always  associated  Avith  a 
wound,  punctured  or  open-inilamed  suppurating,  healing;  with  some  point 
of  irritation  or  suppuration,  even  a  papule  or  pustule;  with  some  centre 
from  which  morbific  elements  may  be  taken  up.  In  what  is  called  a 
simple  wound  the  inflammation  of  the  absorbents  may  be  acute,  but  in 
poisoned  it  is  violent  and  diffused.  The  inflammation  always  follows  the 
course  of  the  absorbents,  leading  from  the  centre  of  absorption  toward 
the  glands;  that  is,  toward  the  body,  and  it  never  spreads  backward. 
When  it  has  reached  the  glands,  the  diseased  action  ceases  to  spread,  that 
is,  it  expends  its  force  upon  the  group  of  glands  in  which  the  absorbents 
naturally  end,  and  does  not  extend  through  another  series  of  absorbents 
to  a  second  group.  When  pyemia  follows  or  comj^licates  the  case,  it  may 
be  open  to  question  whether  the  poisonous  fluid  circulating  in  the  lym- 
phatics has  not  been  allowed  to  pass  into  the  blood  through  its  usual  chan- 
nels, viz.,  throxigh  the  inflamed  glands  onward,  and  set  up  inflammation 
in  the  tubes  and  glands,  was  taken  directly  into  the  blood  through  the 
venous  channels,  thus  giving  rise  to  blood-poisoning. 

2.  Pain  and  tenderness  in  some  of  the  glands  are  generally  early 
symptoms,  and  with  these,  or  some  following  them,  will  be  seen  a  band 
of  redness  varying  in  diameter,  leading  from  the  wound  or  infecting 
centre  toward  the  gland.  This  red  line  may  be  continuous  or  interrupted ; 
it  may  be  a  thin  streak  or  a  broad  stripe  of  redness,  and  in  some  instances 
BO  radiate  into  the  surrounding  tissues  as  to  simulate  erysipelas.  The 
whole  line  of  redness  is  very  painful,  and  with  these  local  symptoms  thera 


DISEASES  OF  TIIK  SI'I.tCION.  513 

will  also  be  some  febrne  disturbance.     The  red  lines  follow  the  course  of 
the  absorbents  and  not  of  the  veins. 

Treatment — AVhen  any  indications  of  absorbent  inflammation  show 
themselves  the  wound  or  sore  should  be  well  cleansed  and  anv  collection 
of  pus  let  out.  The  effected  limb  should  be  raised,  the  foot,  when  in- 
volved, brought  higher  than  the  hip ;  the  hand  or  e.bow  than  the  shoulder, 
and  warm  poppy  fomentations  should  be  applied  along  the  whole  course 
of  the  lymphatics  up  to  the  grouji  of  glands  in  which  they  tenuiuate.  As 
soon  as  suppuration  appears  the  abscess  must  bs  opened,  whether  this 
follows  directly  upon  the  inflammation  or  subsequently.  A  saline  purge 
should  be  administered ;  sedatives  should  be  given  to  allay  pain.  When 
suppuration  has  taken  place  tonics  may  be  administered.  In  chronic 
cases,  where  induration  in  the  track  of  the  ducts  remains,  mercurial  oint- 
ment and  friction  are  sometimes  valuable 

DISEASES  OF  THE  DUCTLESS  GLANDS. 

The  glands  without  any  outlet  in  the  body  are  three  m  number, 
namely:  the  thyr-oid,  situated  in  the  front  of  the  neck;  the  sjileen,  located 
in  the  left  side  below  the  heart,  and  the  supra-renal  capsules,  which  are 
placed  one  over  each  kidney,  deep  in  the  loins  on  either  side  of  the  spinal 
column.  Although  the  functions  of  these  organs  are  still  tmdetermined, 
many  of  their  diseases  are  well  knov?n. 

DISEASES  OF  THE  SPLEEN  (SPLENITIS). 

Symptoms. — Diseases  of  the  spleen  may  be  acute  or  chronic.  The 
acute  symptoms  are  a  sensation  of  cold  and  partial  rigor,  a  feeling  of 
weight,  fullness  and  pain  in  the  left  side  extending  to  the  left  shoulder, 
increased  on  pressure  and  coughing ;  thirst ;  some  degree  of  nausea ;  dry 
cough  with  the  usual  symptoms  of  pyrexia.  Wandering  pains  in  the 
limbs,  sometimes  ending  in  collections  of  pus  under  the  integuments  of 
the  thigh,  arm,  and  so  forth,  are  not  uncommon  in  chronic  splenitis.  In 
the  latter  periods  of  the  disease  the  debility  and  emaciation  become  very 
great;  the  complexion  darkens  and  the  appetite  fails.  Hectic,  more  or 
less  violent,  comes  on  with  diarrhoea  or  vomiting  of  imconquerable  per- 
tinacity and  blood  is  frequently  discharged  both  upward  and  downward. 

There  is  a  simple  enlargement  of  the  spleen  from  mere  temporary 
congestion,  as  when  brought  on  by  sudden  mental  emotion  or  by  oscilla- 
tions of  the  circulation  from  internal  causes.  In  temperate  climates  the 
33 


514  DISEASES  OF  THE  CIECULATOET   SYSTEM. 

more  permanent  enlargement  or  hypertrophy  of  this  organ,  not  heing 
accompanied  by  the  same  violence  of  constitutional  disease  as  in  the  latter, 
is  usually  of  a  passive  character  and  is  owing  to  relaxation  of  fibre.  The 
most  frequent  causes  of  enlarged  spleen  are  ague  (ague  cake)  and  remit- 
tent fever.  The  most  characteristic  symptoms  are  a  sense  of  weight  in  the 
left  side  with  or  without  evident  swelling ;  inability  to  lie  on  the  right  side 
with  ease ;  debility ;  disordered  stomach ;  dry  cough  and  absence  of  fever. 

Treatment — The  indications  of  treatment  are:  first,  to  remove  the 
cause ;  secondly,  to  restore  the  organ  to  its  natural  condition ;  and  thirdly, 
to  improve  the  general  health.  If  ague  be  the  exciting  cause  it  must  be 
combated  by  appropriate  remedies,  warm  and  brisk  purgatives  should  be 
given  once  or  twice  a  week  so  as  to  affect  the  upper  bowels.  Mercurials 
should  be  omitted.  The  bowels  being  kept  more  open  than  ordinary,  the 
nascent  irritative  stage  having  gone  by  and  the  case  being  strictly  pas- 
sive, tonics  are  to  be  bad  recourse  to  and  especially  the  acids  with  prepara- 
tions of  iron. 

Leucocytheinia. — Leucocythemia  or  white-cell  blood  is  a  disease  of 
the  circulating  fluid  often  associated  with  enlargement  of  the  spleen  and 
supposed  to  be  caused  in  part  by  the  morbid  condition  of  that  organ.  The 
great  characteristic  of  this  malady,  as  its  name  indicates,  is  the  pre- 
ponderance of  Avhite  corpuscles  in  the  blood. 

Symptoms. — The  general  or  constitutional  symptoms  are  a  slowly  pro- 
gressive anemia,  weakness  and  emaciation,  with  incapacity  for  exertion, 
shortness  of  breath  and  digestive  derangements.  The  bodily  temperature 
is  often  somewhat  raised  and  sometimes  persistently  elevated.  The  urine 
may  be  normal  in  appearance  but  less  urea  appears  to  be  secreted  in  it. 
In  the  later  stages  there  is  a  tendency  to  dropsy  and  to  hemorrhage  from 
various  surfaces,  especially  the  mucous  membranes.  The  only  certain 
mode  of  determining  this  remarkable  disease  is  by  a  microscopic  examina- 
tion of  the  blood. 

Treatment. — ISTo  specific  for  leucocythemia  has  yet  been  discovered. 
The  constitution  requires  generous  support,  if  not  stimulation.  Tincture 
of  the  chloride  of  iron  in  doses  of  ten  or  fifteen  drops  three  times  a  day 
sometimes  acts  admirably. 

DILATATION  OF  THE  HEART. 

Symptoms. — Dilatation  of  the  heart  is  indicated,  upon  physical  ex- 
ploration, when,  with  extended  impulse  of  the  heart  we  have  duUnesa  on 


EITLAEGEMENT   OF  THE  HEAET.  &15 

percussion  beyond  the  usual  limits.  If  true  hypertrophy  or  muscular 
thickening  be  present  the  impulse  is  very  forcible  as  well  as  extended. 
The  heart-sounds  are  apt  to  be  clear,  though  not  lovid,  in  attenuated  dila- 
tation; rather  loud,  but  dull-toned,  in  enlargement  with  thickening.  It 
is  most  often  induced  by  valvular  obstruction  or  regurgitation,  com- 
pelling unusual  and  continued  eiiorts  to  sustain  this  circulation.  Some- 
times, however,  it  is  more  truly  idiopathic,  following  causes  of  over- 
action  of  a  heart  otherwise  sound,  thus,  violent  exercise,  self -abuse,  coffee, 
tobacco,  alcohol,  and  so  forth,  are,  with  good  reason  in  predisposed  cases, 
accused  of  producing  it. 

Treatment — In  the  treatment  avoidance  of  such  exciting  causes  and 
particularly  of  violent  exercise,  alcohol  and  venery,  is  the  main  principle. 
Robust  or  plethoric  patients  may  bear  and  be  benefited  by  occasional  leech- 
ing or  cupping  over  the  heart.  Acetate  of  lead  as  an  astringent  cardiac 
sedative  has  proved  useful  in  the  dose  of  one  grain  thrice  daily,  with  care 
to  avoid  saturnine  poisoning.  Digitalis  here  acts  as  a  tonic  to  the  heart, 
through  ganglionic  influences,  lessening  rapidity  of  action  when  that  de- 
pends on  debility,  and  veratnim  viride  as  a  sedative  and  palliative  in 
violent  acceleration  of  the  pulse,  as  in  muscular  hypertroj^hy  and  in  some 
forms  of  palpitation. 

ENIAEGEMENT  OF  THE  HEART. 

Symptoms. — Enlargement  of  the  heart  and  its  extent  are  easily  deter- 
mined by  means  of  physical  signs,  palpation  and  percussion.  By  the  touch 
it  is  found  that  apex  beat  is  more  or  less  lowered  and  carried  to  the 
left  of  its  normal  situation.  Between  the  apex  and  the  base  of  the  organ 
are  found  impulses  not  perceptible  in  health.  By  percussion  the  bound- 
aries of  the  organ  are  readily  ascertained  in  the  great  majority  of  cases. 
The  vocal  resonance  also,  as  heard  with  the  stethoscope,  enables  the  physi- 
cian to  define  the  limits  to  which  the  organ  extends.  Palpitation  and  aus- 
cultation furnish  signs  by  which  predominant  hypertrophy  may  be  differ- 
entiated from  dilatation.  If  hypertrophy  predominates  the  impulses  of 
the  heart  as  felt  by  the  hand  are  strong,  and  often  there  is  a  heaving  move- 
ment extending  over  the  region  of  the  heart.  The  first  sound  of  the  heart, 
over  the  apex,  is  abnormally  loud,  long  and  booming.  On  the  other  hand, 
if  dilatation  be  considerable  or  great,  weakness  of  the  organ  is  denoted  by 
feeble  impulses  and  by  diminished  intensity,  together  with  shortness  and 


510 


DISEASES   OF   THE   ClKCULATOItV    SYSTEM. 


a  valvular  quantity  of  the  first  sound  of  the  heart  in  the  situation  of  the 
apex. 

Treatment.- — In  addition  to  purgatives  we  have  seen  the  most  decided 
advantage  result  from  diuretics,  and  not  only  when  there  was  dropsy,  but 
equally  when  there  was  none.  Their  mode  of  operation  appears  to  be 
ultimately  the  same  as  that  of  jjurgatives,  viz.,  they  drain  off  the  serous 
portion  of  the  blood.  We  have  found  many  patients,  conscious  of  the 
benefit  which  they  derived  from  this  class  of  remedies,  to  be  in  the  con- 
stant habit  of  taking  cream 
of  tartar,  brown  tea  and  other 
similar  pojjular  medicines. 
One  patient,  affected  with, 
contraction  of  the  mitral 
valve  to  the  size  of  an  ordin- 
ary pea,  by  these  means 
warded  off  dropsy  beyond  the 
slightest  edema  of  the  feet 
for  ten  years.  When  decided 
dropsy  appears  it  must  be 
combated  by  the  most  efficient 
diuretics,  the  acetate,  or  tar- 
trate and  nitrate  of  potash, 
squill,  digitalis,  spirits  of 
nitre,  etlier,  and  so  forth,  as 
no  class  of  remedies  is  more  variable  and  uncertain  than  this.  When  one 
fails  another  should  be  resorted  to. 

Diet — The  treatment  consists  of  a  highly  nutritious  diet,  into  which 
fatty  articles  should  enter  sparingly,  together  with  the  employment  of 
hygienic  measures  and  remedies  designed  to  give  tone  to  and  to  invigorate 
the  heart. 

CHRONIC  VALVTJLAR  DISEASE. 


RAV 
Bird's-Eye   View   of   the   Valves   of  the   Heart. 


Diagnosis — The  diagnosis  of  valvular  disease  has  been  rendered  very 
complete  by  means  of  auscultation.  With  very  rare  exceptions  it  gives 
rise  to  adventitious  sounds  or  murmurs,  the  characters  of  which,  as  re- 
gards their  situation,  their  transmission  in  different  directions,  and  their 
relations  to  the  heart  sounds,  enable  the  physician  not  only  to  determine 
their  existence  but  to  localize  tliem  and  to  distinguish  between  those  which 
involve  obstruction   and   regurgitation.      When  valvular   disease   has   ad- 


CHKONIC    VALVULAK    DISEASE.  517 

vanced  sufficiently  to  produce  obvious  symptoms  referable  to  eitber  ob- 
struction or  regurgitation,  or  to  both,  they  will  destroy  life  sooner  or  later. 

Whether  the  disease  of  the  valves  be  cartilaginous,  osseous,  or  con- 
sist of  vegetations,  the  general  symptoms  are  the  same  if  the  degree  of 
contraction  be  equal.  The  general  sjanptoms  are  cough,  copious  watery 
expectoration,  dyspnoea,  orthopnoea,  frightful  dreams  and  starting  from 
sleep.  Edema  of  the  lungs,  pulmonary  apoplexy,  passive  hemoptysis 
(sputa  stained  with  dark  or  grumous  blood),  turgescence  of  the  jugular 
veins,  lividity  of  the  face,  anasarca,  injection  of  almost  all  the  mucous 
membranes,  passive  hemorrhages,  esiiecially  of  the  mucous  membi'anes, 
engorgement  of  the  liver  spleen,  and  so  forth,  and  congestion  of  the  brain 
with  symptoms  of  oppression,  sometimes  amounting  to  apoplexy. 

The  preceding  illustration  represents  a  hardened  section  of  the 
heart,  cut  transversely  across  the  organ  so  as  to  show  how  the  pocket-like 
valves  come  together  in  the  middle  of  the  openings  in  order  to  close  those 
orifices.  At  LAV  are  seen  the  two  flaps  of  the  mitral  valve,  which  shuts 
off  the  return  current  of  the  blood  as  it  is  being  driven  by  the  strong 
left  ventricle  into  the  aorta,  and  at  Ao  are  depicted  the  three  flaps  of  the 
aortic  valve,  which  is  closed  by  the  return  current  of  the  blood  from  the 
great  aorta  after  it  is  pumped  into  that  large  blood-vessel  by  the  ventric- 
ular contraction.  It  is  plain  to  be  seen  that  if  the  edges  of  these  valves 
are  rough  or  ragged  or  perforated,  they  cannot  shut  tightly  and  will  allow 
some  leakage  to  occur. 

Symptoms. — When  the  disease  is  combined  witli  liypertrophy  or  dila- 
tation, as  is  commonly  the  case,  the  symptoms  are  more  severe  than  those 
of  hypertrophy  or  of  dilatation  alone,  the  paroxysms  of  palpitation  and 
dyspnoea  in  particular  being  more  violent,  more  obstinate  and  more  easily 
excited.  The  action  of  the  heart  is  irregular.  The  pulse  is  small,  weak, 
intermittent,  irregular  and  unequal. 

Treatment — Since  we  can  neither  replace  or  repair  the  damaged 
valves  of  the  heart,  the  principles  of  treatment  for  chronic  valvular 
disease  are,  in  general  terms,  such  as  diminish  the  force  and  activity  of  the 
circulation,  occasional  venesection  to  a  moderate  extent,  an  unstinailating 
and  rather  spare,  though  sufficiently  nutritious  diet,  a  tranquil  life,  with 
respect  both  to  the  body  and  the  mind,  and  a  good  state  of  the  digestive 
organs  and  alimentary  canal. 

When  there  is  dropsy  diuretics  are  of  the  greatest  utility.  They  are 
remarkably  beneficial  in  an  anterior  stage  of  the  disease ;  for,  by  drawing 
off  the  serous  portion  of  the  blood,  they  diminish  the  quantity  without 


518  DISEASES  OF  THE  CIRCULATOET   SYSTEM. 

deteriorating  the  quality  of  the  fluid,  and  thus  relieve  palpitation  and 
dyspnoea  and  obviate  infiltration,  without  materially  reducing  the  patient. 
When  diuretics  do  not  remove  dropsy  and  purgatives  have  failed,  the 
practitioner  is  compelled  to  resort  to  puncturing.  We  say  compelled,  be- 
cause the  remedy  is  a  last  and  dangerous  resource.  The  danger,  however, 
may  be  considerably  diminished  by  making  small  punctures  with  a  grooved 
needle,  and  allowing  the  fluid  to  ooze  slowly  during  four  or  five  days  or  a 
week.  When  incisions  are  made  with  a  scalpel  or  lance,  the  fluid  is 
evacuated  quickly,  as  in  twelve  or  forty  hours,  and  the  patient,  according 
to  our  observation,  generally  dies. 

FAINTING  OR  SYNCOPE. 

Complete  and,  commonly,  sudden  loss  of  sensation  and  motion  with 
considerable  diminution  or  entire  suspension  of  the  pulsations  of  the  heart 
and  respiratory  movements. 

Symptoms. — It  is  to  be  distinguished  from  an  epileptic  or  apoplectic 
fit  by  the  fuller  and  apjiareut  failure  of  the  pulse  and  respiration,  as  well 
as  by  the  previous  history,  if  that  can  be  obtained  from  friends  or  by- 
standers. 

Treatment. — Syncope  is,  commonly,  an  affection  of  no  consequence, 
but  sometimes  it  is  an  index  of  diseased  heart.  Generally  recovery  from 
a  swoon  is  rapid  if  the  patient  is  laid  flat  upon  the  ground,  without  any 
pillow,  the  clothing  loosened  from  the  neck  and  a  little  cold  water 
sprinkled  in  the  face  and  the  apiDlication  of  volatile  substances  to  the 
nostrils  are  all  that  will  be  required  during  the  fit.  If  recovery  is  delayed 
a  turpentine  injection  or  one  containing  a  little  whiskey  and  water  should 
be  administered,  and  the  electro-magnetic  current  may  be  transmitted 
through  the  walls  of  the  chest  to  stimulate  the  failing  powers  of  the  lungs 
and  heart. 

PALPITATION. 

Symptoms. — All  excessive  or  consciously  disturbed  action  of  the  heart 
is  commonly  thus  designated.  Over-action  in  particular  may  have  either 
one  of  the  following  origins:  Nervous  or  hysterical,  dyspeptic,  rheumatic 
or  gouty,  hypertrophic. 

All  of  the  above  forms  of  merely  functional  disturbance  of  the  heart, 
and  especially  the  purely  nervous,  may  be  known  from'  hypertrophic  over- 
action,  or  the  conscious  impulse  of  dilatation  of  the  heart,  by  the  fact 


AHQINA  PECTOKIS   OK   IIEAET  PANG.  519 

that  they  are  not  increased  by  moderate  exercise ;  are  often,  indeed,  much 
diminished  thereby. 

Treatment. — The  treatment  must  vary  according  to  its  cause.  If 
nervous,  invigoration  of  the  system  and  enrichment  of  the  blood  are  most 
probably  required,  by  iron  and  other  tonics  and  regimen.  Dyspepsia  will 
require  appropriate  treatment ;  as  a  part  of  which  exercise  in  the  open  air 
will  not  be  counter-indicated  at  all  by  sympathetic  palpitation. 

ANGINA  PECTORIS  OR  HEART  PANG. 

Symptoms. — It  is  a  disease  of  an  intermitting  character  in  which  the 
patient  has  intervals  of  comparative  ease  or  perfect  health  between  par- 
oxysms of  greater  or  less  suffering.  It  is  characterized  by  sudden  attacks 
of  severe  pain,  extending  from  jhe  heart  along  the  left  arm,  with  a  sense 
of  stricture  in  the  chest,  prostration  and  alarm.  The  pain  is  rarely  con- 
fined to  its  primary  and  principal  site  in  the  cardiac  region,  but  increases, 
in  different  instances,  very  variously  both  in  direction  and  extent.  It 
shoots  upward  or  downward  or  to  the  right  side  and  almost  always  through 
the  left  side  of  the  chest  toward  the  shoulder  and  axilla  and  very  fre- 
quently into  the  left  arm. 

.  Treatment — The  violence  of  the  patient's  sufferings  and  the  belief 
in  the  nervous  or  spasmodic  nature  of  the  pain,  suggested  by  its  sudden 
invasion,  would  naturally  lead  the  medical  attendant,  in  the  first  place,  to 
attempt  to  afford  relief  by  anodynes ;  siich  attempts,  however,  have  gener- 
ally been  attended  with  less  success  than  might  have  been  expected.  In 
angina,  as  in  toothache  or  tic  douloureux,  gastralgia,  colic,  or  other  violent 
pains,  nature  seems  as  if  she  scorned  to  be  controlled  by  art,  although  so 
much  under  the  influence  of  similar  applications  when  less  needed,  as  in 
the  case  of  milder  pains.  Antispasmodics,  cordials,  carminatives,  and  so 
forth,  have  been  much  recommended  and  employed ;  and,  upon  the  whole, 
with  better  success  than  anodynes.  The  inhalation  of  one  or  two  drops  of 
nitrate  of  amyl  sometimes  relaxes  the  spasm  and  affords  prompt  relief. 
Small  doses  of  nitro-glycerlne  and  hypodermic  injections  of  from  one- 
eighth  to  one-half  grain  of  morphia  also  partly  relieve  the  pain  after  a 
little  longer  delay.  But  although  these  or  other  means  may  afford  relief, 
or  may  even  ward  off  death,  it  is  evident  that  every  kind  of  treatment 
confined  to  the  paroxysm  is  of  very  slight  importance.  Compared  with 
that  which  is  to  be  employed  in  the  interval,  the  former  can,  at  most, 
afford  temporary  relief ;  the  latter  may  cure  the  disease. 


520  DISEASES  OF   THE   ClUCULATOKT   SYSTEM. 


HEAUT  ASTHMA, 

Symptoms Asthma   from   disease  of  tlie  heart  often  imitates  the 

characters  of  the  other  varieties,  and  this  jierhaps  for  a  very  simple  reason ; 
that  the  lungs  are  in  much  the  same  state  as  in  those  varieties.  Thus  the 
asthma  is  humid  or  humeral  when  there  is  permanent  engorgement  of 
the  lungs,  causing  copious  sero-mucous  effusion  into  the  air  passages,  as 
in  cases  of  contraction  of  the  mitral  valve.  It  is  dry  Avhen  the  engorge- 
ment is  only  transitory,  as  in  cases  of  pure  hypertrophy.  It  is  continued 
■when  there  is  a  permanent  obstruction  to  the  circulation,  and  may  be  con- 
vulsive when  the  heart  has  svifiicient  power  to  palpitate  violently. 

Treatment — Numberless  remedies  have  been  tried ;  among  them 
stramonium,  nitrate  of  amyl,  chloroform  inhalations,  and  so  forth. 
Arsenic  enjoys  full  favor  and  deservedly  holds  an  important  rank  as  a 
therapeutic  agent. 

DISEASES  OF  THE  ARTERIES. 

The  larger  blood-vessels,  both  arteries  and  veins,  are  liable,  like  the 
heart  itself,  to  various  structural  changes  in  disease,  which,  of  course,  lead 
to  more  or  less  serious  disturbances  in  the  circulation  of  the  blood. 

Symptoms. — Arteritis  or  inflammation  of  the  substance  of  a  blood- 
vessel, commonly  commencing  with  the  inner  coat  of  the  artery  and  ex- 
tending throiigh  the  whole  structure  of  the  wall  of  the  tube,  is  a  rare  af- 
fection and  scai-cely  ever  detected  before  deatL 

Fatty  and  calcareous  degenerations  of  the  arteries  are  much  more 
common,  and  consist  in  the  deposit  of  fatty  or  chalky  material  in  th.r,- 
arterial  walls,  generally  in  patches  varying  in  size  from  a  mere  speck  t . 
an  inch  or  more  in  diameter.  This  condition  is  commonly  spoken  of  a? 
a  hardening  of  the  arteries. 

Treatment — These  diseases  do  not  occur  until  after  middle  life,  and 
no  satisfactory  treatment  has  been  found. 


PART  VI  OF  BOOK  IV 

Treats  of  the  diseases  of  the  respiratory  system,  their 
causes,  symptoms  and  treatments. 


Acute   Bronchitis    533 

Acute  Laryngitis   526 

Symptoms  of   526 

Treatment    of    526 

Acute  Phthisis    543 

Symptoms   of    543 

Treatment  cf   544 

Aphonia     529 

Treatment  r  f 529 

Asthma    523 

Causes  of   523 

Hay    S^S 

Symptoms  of 524 

Treatment    of    524 

Bends,   The    5Si 

Bronchial  Catarrh    530 

"ronchitis     532 

Acute 533 

Capillary    532 

Chronic    533 

Diet  in  533 

Simple    532 

Treatment   of    533 

Capillary   Bronchitis    53a 

Symptoms  of 532 

Catarrh,   Bronchial    530 

Caisson     551 

Cause  of  551 

Symptoms   of    552 

Treatment   of    552 

Catarrhal  Laryngitis    526 

Catarrh,  Nasal   525 

Chronic  Bronchitis   533 

Causes  of  533 

Treatment   of    534 

Chronic  Laryngitis   526 

Symptoms  of  527 

Treatment  of   527 

Chronic   Pulmonary   Consumption.  .544 

Symptoms  of  S44 

Treatment  of  S46 


Cold  in  the   Head   525 

Compressed  Air  Disease   551 

Consumption   543 

Causes  of   543 

Chronic   Pulmonary    544 

Galloping     543 

Hofif  Prescription  for  547 

Coryza    525 

Cough     530 

Causes  of   530 

Symptoms   of    530 

Treatment   of    530 

Croup    528 

Cold,  Rose  525 

Diseases  of  the  Respiratory  System. 523 

Distension  of  the  Lungs    537 

Dropsical   Laryngitis    526 

Emphysema    537,   550 

Causes  of  537 

Symptoms   of    J3  7 

Treatment  of 538 

Fever,  Hay   ; 525 

Galloping   Consumption    543 

Hay  Asthma   S25 

Hay  Fever   525 

Causes  of   ■ 525 

Symptoms  of   525 

Treatment   of    525 

Hoff  Prescription  for  Consumption, .547 

Hydrothorax   550 

Inflammation  of  the   Larynx   526 

of  the  Lungs   534 

Laryngitis    526 

Acute    526 

Catarrhal     526 

Chronic    526 

Dropsical    526 

Laryngoscope,   The    528 

Larynx,   The    529 

Inflammation  of  526 

Loss  of  Voice  529 


521 


622 


INDEX  TO   PART   VI  OF   BOOK  IV. 


Lung  Distension 537 

Lungs,  Inflammation  of 534 

Nasal  Catarrh 525 

Causes  of  525 

Symptoms  of 525 

Treatment  of   525 

Outdoor  Sleeping  in  Tuberculosis 541 

Paralysis  of  the  Vocal  Cords  5-^8 

Phthisis,  Acute 543 

Pulmonary  543 

Pleurisy 54^ 

Causes  of    548 

Diet  in 55'' 

Symptoms  of   548 

Treatment  of   549 

Pneumonia 534 

Causes  of  534 

Diet  in 537 

Symptoms  of 534 

Treatment  of 536 


Pneumothorax SSO 

Pulmonary  Phthisis   543 

Respiratory  System,  Diseases  of 523 

Rose  Cold   525 

Simple  Bronchitis   532 

Symptoms  of 532 

Throat  Ulcers 528 

Treatment  of 528 

Tuberculosis    538 

Cause  of  539 

Outdoor  Sleeping  in 541 

Symptoms  of   539 

Treatment  of 539 

Tumors  in  Vocal  Cords 528 

Ulcers,  Throat  528 

Vocal  Cords   52S 

Paralysis  of 528 

Tumors  in   528 

Voice,  Loss  of  529 


ILLUSTRATIONS 


Lungs  and  their  Diseases,  The 535 

Muscles  of  the  Larynx  529 

Positions  of  the  Vocal  Cords  528 


Vocal  Apparatus   527 

Vocal  Cords,  Positions  of 528 


CURATIVE    MEDICINE 


PART  VI 

DISEASES  OF  THE  RESPIRATORY  SYSTEM 

ASTHMA. 

Causes — An  exciting  cause  may  be  an  impurity  of  the  blood.  More 
commonly  it  arises  from  indigestion,  bronchitis  or  valvular  disease  of  the 
heart.  Hay  asthma  is  caused  by  the  inhalation  of  particles  such  as  arise 
from  dried  hay.  The  pollen  from  flowers  and  also  from  dogs,  cats  and 
other  animals  frequently  give  rise  to  it. 

Symptoms. — This  disease  comes  on  in  paroxysms.  The  paroxysm  may 
be  preceded  for  a  variable  time  by  a  sense  of  oppression  and  constriction 
about  the  chest,  with  wheezing  respiration.  "In  many  instances,  however, 
it  develops  without  any  warning  and  most  commonly  at  night.  The  pa- 
tient awakes  suddenly,  scarcely  able  to  breathe,  and  is  forced  to  assume 
the  sitting  posture,  or  even  to  stand  erect,  with  the  shoidders  raised  and 
fixed,  the  head  thrown  back,  the  mouth  open  and  all  the  extraordinary 
muscles  of  respiration  brought  into  play  to  assist  those  powers  of  the 
system  which  are  usually  sufficient  for  the  purpose.  The  face,  in  severe 
cases,  wears  an  aspect  of  terror,  the  eyes  are  widely  opened,  the  skin  is 
pale  and  dusky  and  often  bedewed  with  sweat.  The  feet  and  hands  are 
cold  and  the  pulse  small  and  quick.  The  breathing,  however,  is  not  hur- 
ried, but  inspiration  is  short  and  jerky  and  expiration  inordinately  pro- 
longed. On  jjercussion,  the  resonance  of  the  chest  is  found  to  be  increased 
and  auscultation  shows  the  vesicular  breath-soimds  are  weak  or  suppressed 
and  attended  with  whistling  or  cooing  noises  called  rales.  Toward  the 
end  of  an  attack,  which  may  last  for  several  weeks,  cough  comes  on  with 
the  expectoration  of  small,  fimi,  solid  pellets  of  mucus,  in  rare  cases  mixed 
with  blood.  The  duration  varies  greatly,  the  paroxysm  passing  off  in  a 
few  minutes  or  lasting  for  many  days.    When  it  continues  long,  or  is  left 

(523) 


524  DISEASES   OF  THE   RESPIRATOET   SYSTEM. 

to  itself,  it  is  apt  to  subside  gradually ;  but  if  brief  or  cut  short  by  treat- 
lueut.  it  often  ends  abruptly. 

Diagnosis. — The  diagnosis  rests  upon  the  paroxysmal  and  usually 
sudden  nature  of  the  onset,  the  absence  of  moist  rales  as  determined  by 
auscultation,  and  the  complete  recovery  of  patients  in  the  intervals  of  their 
attacks.  The  cooing  and  whistling  sounds  heard  all  over  the  chest  show 
the  absence  of  any  serious  obstruction  in  the  larynx  and  trachea,  and  the 
muscular  effort  being  made  for  the  purpose  of  inflating  the  lungs  chiefly 
in  asthma,  from  heart  disease,  instead  of  also  in  exjiiration  as  in  the 
sjiasmodic  form,  which  we  are  now  considering,  is  another  indication  of 
value. 

Treatment. — 1.  Among  the  most  certain  treatments  are  the  inhalation 
of  chldroform  or  ether  and  the  hvpodorniic  injection  of  an  eighth  or  a 
quarter  of  a  grain  of  morphia,  either  of  which,  in  a  majority  of  instances, 
may  be  depended  on  to  relax  the  spasm  and  afford  jirompt  relief. 

2.  Some  of  the  most  reliable  internal  remedies  are  chloral  in  fifteen- 
grain  doses,  which  shoidd  be  employed  with  gi-eat  caution,  or  not  at  all 
if  the  heart  is  organically  affected ;  ten  or  fifteen  drops  of  tincture  of 
lobelia  or  of  ipecacuanha,  as  a  nauseant  or  emetic,  belladonna,  valerian 
and  strong  black  coffee. 

3.  The  inhalation  of  the  vapor  of  stramonium  leaves,  produced  either 
by  burning  them  on  a  red-hot  shovel  or  smoking  them  in  a  pipe,  and  of 
the  smoke  of  soft  bibulous  paper  which  has  been  soaked  in  strong  salt- 
pet-e  water  and  then  dried,  often  affords  relief,  and,  perhaps,  as  often 
fails  in  its  desired  object. 

4.  The  treatment  during  the  interval  lietween  the  paroxysms  must  be 
directed  toward  building  np  the  general  health  and  fortifying  the  nervous 
system  against  the  exciting  causes  of  the  disease.  In  some  instances  the 
action  of  small  doses  of  lobelia  is  highly  b.Mieficial,  and  in  others,  patients 
who  have  been  for  years  great  sufferers  from  asthma  enjoy  a  complete 
immunity  from  the  malady  as  long  as  tliey  keep  themselves  under  the 
influence  of  iodide  of  potassium  by  taking  from  five  to  ten  grains  of  it 
three  times  daily. 

5.  If  medicinal  treatment  for  the  prevention  of  asthma  proves  unsuc- 
cessful, a  change  of  climate  and  particularly  a  sea  voyage  should  be  under- 
taken, and  it  is  claimed  by  some  physicians  in  Colorado  that  the  air  of  that 
region  is  almost  a  specific  against  asthmatic  complaints. 


NOSE    CATAKBH.  525 


HAY  FEVER. 


Symptoms. — Hay  asthma  or  rose  cold,  commonly  called  hay  fever,  is 
a  very  prevalent  form  of  asthmta  which  comes  on  with  symptoms  of 
ordinary  but  severe. cold  in  the  head,  constant  sneezing,  gi'eat  discharge 
from  the  nose  and  in  many  eases  intense  diificulty  of  breathing.  Many 
sufferers  from  this  curious  malady  are  perfectly  well  imtil  a  certain  day 
in  one  of  the  months  of  June,  Jidy  or  August  of  every  year,  when  they 
wake  up  in  the  morning,  perhaps,  with  the  symptoms  above  described. 

Causes. — As  already  remarked,  this  form  seems  to  be  due  to  the 
inhalation  of  pollen  from  certain  grasses  or  flowers,  but  when  once  com- 
menced it  may  continue  for  several  days,  or  even  weeks,  after  its  sup- 
posed cause  has  been  removed. 

Treatment — The  inhalation  of  sulphate  of  quinine  in  powder  has 
been  highly  recommended  in  this  aifection,  but  the  air  (and  other  attrac- 
tions) of  various  watering  places  seems  to  be  the  most  popular  and  satis- 
factory remedy.  The  White  Mountains  or  certain  seaside  resorts  are 
looked  upon  by  some  patients  as  absolutely  necessary  for  their  health  and 
comfort  during  an  attack  of  this  complaint.  Adrenalin  used  in  an  atom- 
izer three  to  six  times  a  day  will  afford  great  relief. 

Various  Forms  of  Asthma. — Under  the  title  of  industrial  asthma  have 
been  grouped  several  kinds  of  jjulmonary  disease,  incident  to  different 
trades  and  occupations.  These  include  saw-grinder's  asthma,  miner's 
asthma,  potter's  asthma  and  miller's  asthma,  caused  by  the  mechanical 
irritation  of  minute  particles  of  dust  in  the  respired  air. 

NOSE  CATARRH. 

Symptoms — This  disease,  so  well  known  to  every  one  as  a  common 
"cold  in  the  head,"  is  often  epidemic,  and  is  characterized  at  first  by 
chilliness  with  sneezing  and  later  by  an  abundant  discharge  of  fluid  from 
the  nose.  \\^hen  severe  it  is  attended  with  slight  fever,  pain  and  sense  of 
weight  in  the  head,  pain  in  the  limbs,  prostration  of  strength,  irritability 
of  temper  and  inactivity  of  mind. 

Causes — Its  origin  can  generally  be  traced  to  some  imprudent  viola- 
tion of  the  laws  of  hygiene,  such  as  exposure  to  dravights,  insufficient 
clothing,  sudden  cooling  when  heated,  and  so  forth. 

Treatment — The  number  and  diversity  of  the  infallible  remedies  for 
a  common  cold  is  sufficient  evidence  of  their  generally  unsatisfactory 


526  DISEASES   OF  THE  RESPIEATOET  SYSTEM. 

nature,  but  as  the  natural  duration  of  the  disase  is  from  three  to  five 
days,  the  third  or  foiirth  medicine  which  receives  twenty-four  hours'  trial 
often  gains  the  credit  of  accomplishing  a  cure.  If,  as  is  usually  the  case, 
the  bowels  are  constipated,  a  saline  purgative,  such  as  a  Seidlitz  powder 
or  a  bottle  of  citrate  of  magnesia,  will  usually  relieve  the  headache,  and 
then  light  diet,  abstinence  from  fluids  for  a  day  and  ten  grains  of  Dover's 
powder  at  bed-time  often  seem  to  hasten  the  departure  of  this  unwelcome 
guest. 

LAHYNGITIS  OE  INFLAMMATION  OF  THE  LARYNX. 

Three  Forms. — This  disease,  which  is  one  of  the  accompaniments  of  a 
common  cold  whenever  hoarseness  of  the  voice  comes  on,  presents  itself 
iinder  three  forms:  First,  the  acute  or  edematous;  second,  the  subacute 
or  catarrhal,  and  third,  chronic  laryngitis.  The  first  of  these  varieties 
may,  if  not  properly  treated,  prove  quickly  fatal,  by  closing  up  the 
avenue  of  entrance  for  the  air  to  the  limgs  and  thus  causing  death  by 
suifocation. 

Symptoms  of  Acute  Form. — Acute  or  dropsical  laryngitis  may  com- 
mence as  a  slight  catarrh,  quickly  followed  by  high  fever.  Speech,  cough 
and  respiration  are  all  soon  modified.  The  voice  at  first  metallic,  soon 
becomes  whispering.  The  cough  primarily  clear  and  shi'ill,  then  harsh 
and  croupy,  is  also  reduced  to  little  more  than  a  whisper,  and  a  peculiar 
noise  like  a  loud  whisper  accompanies  both  inspiration  and  expiration, 
which  are,  from  the  beginning  almost,  laborious  and  wheezing.  As  soon 
as  the  dropsical  swelling  comes  on  and  still  further  narrows  the  opening 
of  the  glottis,  the  effort  to  breathe  becomes  exceedingly  painful  and 
difiicult  and  the  patient's  countenance  expresses  great  anxiety. 

Treatment — 1.  Since  acute  laryngitis  in  the  adult  may  destroy  life  in 
a  few  days,  or  even  hours,  it  should  be  treated  actively  from  the  first  onset 
by  bleeding,  if  the  patient  is  robust,  or  by  leeching,  active  purgation  with 
five-  or  ten-grain  doses  of  calomel  and  jalap  and  calomel  in  grain  doses 
every  two  hours  to  the  extent  of  producing  slight  salivation  as  rapidly  as 
possible. 

2.  If  the  inflammatory  swelling  proceeds  or  if  dropsy  comes  on  and 
interferes  with  the  respiration  sufficiently  to  cause  lividity  or  blueness 
of  the  lips,  the  operation  of  opening  the  windpipe  should  be  at  once  per- 
formed. It  is  better  to  open  the  trachea  or  windpipe  sooner  than  is  abso- 
lutely necessary,  than  to  postpone  the  operation  imtil  the  blood  has  been 
rendered  very  impure  by  want  of  a  proper  supply  of  oxygen ;  yet  even  uj) 


LAETNGITIS  OE  INFLAMMATION   OF   THE  LAEYNX. 


527 


to  the  last  gasp  and  for,  perhaps,  a  minute  afterward,  life  may  be  saved 
by  the  surgical  operation. 

3.  For  children  the  danger  to  life  from  this  malady  is  comparatively 
slight,  so  that  bleeding  and  calomel  may  generally  be  dispensed  with,  and 
emetics,  such  as  syrup  of  ipecacuanha  or  Coxe's  hive  syrup,  in  ten-drop 
doses  every  three  hours  for  a  child  of  three  years  old,  with  the  inhalation 
of  warm  opiate  vapors,  as,  for  example,  that  from  the  siwut  of  a  tea- 
pot, in  which  has  been 
placed  with  a  small  quan- 
tity of  boiling  water  fif- 
teen or  twenty  drops  of 
laudanum,  are  generally 
sufficient. 

Subacute  rorm. — The 
subacute  form  of  laryngi- 
tis rarely  passes  into  the 
acute  variety,  and  is, 
therefore,  of  but  little  im- 
portance. If  severe,  the 
same  treatment  by  expec- 
torants, nauseants  and  an- 
odynes, recommended  in 
acute  laryngitis  of  chil- 
dren may  be  employed. 
Complete  rest  of  the  voice 
should  be  enjoined  and 
inhalations  of  the  various 
anodyne  and  astringent 
sprays  are  of  great  service 
in  chronic  cases. 

Chronic  Laryngitis 
Symptoms. — Chronic  laryn- 
gitis is  accompanied  with 
actual  thickening  of  the 
vocal  cords,  which,  if  the 

deposit  be  not  subsequently  absorbed,  produces  a  permanent  change  in  the 
voice.  The  respiration  is  usually  but  little  affected,  yet  there  may  be  a 
little  tickling  cough,  an  expectoration  of  small  fragments  of  mucus  and 
an  almost  constant  desire  to  clear  the  throat. 


Image  of  Vocal  Apparatus  as  Seen  In  the  Laryngoseopio 
Mirror  Held  Far  Back  In  the  Mouth. 


528 


DISEASES  OF  TITK  REf=iPIRATORY  SYSTEM. 


Treatment. — Eest,  by  the  avoidance  o£  sjiealving  above  a  whisper,  a 
wami,  moist  atmosphere  and  medicated  inhalations,  are  the  important 
elements  of  treatment  in  this  affection  in  its  simple  form. 

The  Laryngoscope. — By  means  of  a  small,  metallic  looking-glasa, 
called  a  laryngoscope,  a  view  of  the  epiglottis,  the  glottis  itself,  and,  in 
favorable  instances,  the  interior  of  the  larynx,  with  some  of  the  \ipper 
rings  of  tlie  trachea,  may  be  obtained.  Such  a  view  is  given  in  the  ac- 
companying illustration. 

Treatment  of  Throat  Ulcers — When,  by  means  of  the  laryngoscope, 
the  existence  and  seat  of  an  ulcer  can  be  established,  it 
should  be  touched  with  a  strong  solution  of  nitrate  of 
silver,  in  the  hope  of  thereby  promoting  a  tendency  to 
heal;  or  inhalations  of  astringent  solutions,  such  as  that 
of  the  sulphate  of  zinc,  or  of  copper,  and  of  carbolic. 
acid  may  be  employed. 

TRUE  CROUP  OR  PSEUDO-MEMBRANOUS  CROUP. 

For  a  full  description  of  the  causes  and  treatment 
of  this  disease  see  pages  437,  980,  1272. 

DISEASES  OF  THE  VOCAL  CORDS. 

Tumors  in  Vocal  Cords. — The  develojiment  of  new 
growth  or  little  tiunors  within  the  cavity  of  the  larynx 
is  a  cause  of  local  obstruction  to  the  breathing,  which 
is  iiappily  rare.  The  three  different  kinds  which  have 
been  met  with  are,  first,  the  warty  growths,  having  a 
firm  structure,  and  attached  to  the  inner  surface  of  the 
larvngeal  cavity  by  a  broad  base ;  second,  polypoid 
growths,  .similar  to  those  already  mentioned  as  occurring  in  the  nose,  of 
a  soft  and  jelly-like  consistence  attached  to  the  mucous  membrane  by  a 
pedicle  or  stem;  and,  third,  cysts  or  hollow  bags,  containing,  in  some  in- 
stances, parasites. 

Paralysis  of  Vocal  Cords. — Paralysis  of  the  vocal  cords,  resulting  in 
aphonia  or  loss  of  the  voice,  is  a  very  grave  misfortune  under  certain  cir- 
cumstances, as,  for  example,  to  clergymen  or  lawyers. 

Changes  in  Vocal  Cords. — The  clianges  in  position  which  these  vocal 
cords  undergo  in  the  different  processes  in  which  they  are  concerned,  will 


Changes  of  Position 
of  the  Vocal  Cords. 


DISEASES    Ol''    HIE    VOCAL    COKDS,  529 

probably  be  understood  by  reference  to  the  accompanying  diagram.  At 
A  is  sliown  the  appearance  of  the  chink  of  the  glottis,  formed  by  the  edges 
of  the  vocal  cords,  as  it  appears  when  examined  by  the  laryngoscope 
wiiilst  the  patient  is  engaged  in  singing.  B  exhibits  the  condition  in 
V.  Inch  it  nsnally  appears  during  easy  and  quiet  respiration ;  and  at  C 
is  represented  the  arrangement  during  forced  inspiration  or  drawing  a 
long  breath. 

Muscular  Arrangement  of  Larynx — Tlie  figure  in  the  margin  illus- 
trates the  arrangement  of  the  muscles  of  the  larynx,   as  seen  after  the 
membrane  and  elastic  tissue  constituting  the  vocal  cords  has  been  removed. 
Tli.   represents    the    large    and    firm    thyroid 
cartilage;  Ary  the  upper  ends  of  the  aryte- 
noid cartilages,  to  which  the  posterior  ends 
of  the  vocal  cords  are  attached ;  V  indicates 
the  position  of  the  vocal  cords.     At  Arp  is 
represented   the   band   of  muscle   called   the 
posterior    arytenoid   muscle,    which    has    the 
duty  of  pulling  the  arytenoid  cartilages  to- 
gether,   and    so    narrowing    the    slit    of    the 
glottis  between   the  vocal  cords  as  to  cause 
the   production  of  just   the   right  sound  for 
any  particular  note  in  singing.     The  mechan- 
ism of  hoarseness  in   the  voice  or  cough  is  Muscles  of  the  Larynx, 
simply  as  may  be  understood  with  ease  from 

this  diagram,  that  the  edges  of  the  vocal  cords  becoming  thickened  by 
congestion  or  slight  inflammatory  action  can  no  longer  vibrate  quickly 
enough  1o  pnnluce  the  higher  notes  of  the  voice. 

Loss  of  Voice — In  paralysis  of  the  muscles  of  the  glottis,  which,  small 
as  they  are,  the  explanation  given  a  few  pages  back  shows  to  be  very  im- 
portant, not  only  is  the  power  to  produce  audible  voice  sounds  lost,  but 
breathing  is  rendered  difficult,  and  great  distress  is  produced  by  the 
inability  to  take  a  long  breath.  Aphonia,  or  loss  of  voice,  is  of  two  kinds, 
the  simulated  and  the  true.  An  imitation  of  the  real  disease  is  generally 
hysterical  in  its  character,  and  though  it  may  last  for  a  long  time,  is  never 
really  permanent;  it  may  sometimes  be  recognized  by  the  aid  of  the 
laryngoscope. 

Treatment. — True  aphonia  is  due  to  actual  jialsy  of  these  little  laryn- 
geal muscles,  is  generally  (Ie[i('n(l(>iit  '.ipiin  some  serious  injury  or  disease, 
and    therefore   in  most   instances    iiici:i-ab]o.      The   treatment   of   the   pre- 


530  DISKASES  OF  THE  RESPTEATOET  SYSTEM. 

tended  aphonia  is  that  of  hysteria.  In  bad  cases  chloroform  may  be  given 
with  advantage.  During  the  intervals  between  the  attacks,  the  bitter 
tonics,  cod-liver  oil  and  iron,  and  treatment  for  any  uterine  derangement, 
as  described  in  the  chapter  on  Diseases  Peculiar  to  Women,  should  such 
disorder  exist,  are  strongly  indicated  and  will  generally  accomplish  a  cure 
in  the  course  of  time. 

COMMON  COUGH  OR  BRONCHIAL  CATARRH, 

Character. — This  every-day  disease  is  a  subacute  inflammation  affect- 
ing the  larynx,  trachea,  and  larger  bronchial  tubes,  sometimes  commenc- 
ing with  nasal  catarrh  and  traveling  down,  as  it  were,  to  the  pulmonary 
organs.  At  other  times,  or  in  other  patients,  it  appears  to  originate  in  the 
larjTix,  and  does  not  affect  the  nasal  passages  at  any  time  during  its 
course. 

Predisposing  Causes. — The  predisposing  causes  to  this  common  affec- 
tion are  enumerated  as  being  the  loose,  flabby  texture  of  tissue  in  certain 
individuals,  especially  those  who  are  the  subjects  of  the  scrofulous  dia- 
thesis, and  rickety  children;  second,  a  previous  attack,  and  third,  effem- 
inate modes  of  life. 

Direct  Causes.— The  directly  exciting  causes  are: 

1.  Chilling  of  a  portion  of  the  skin,  and  especially  the  change  of 
temperature  of  a  portion  of  the  body  produced  by  sitting  in  a  draught  of 
air  whilst  perspiring  freely,  or  with  damp  clothing  or  wet  shoes. 

2.  Irritants  acting  directly  on  the  mucous  membrane  lining  the  air- 
passages,  such  as  diist,  acrid  vapors,  or  hot  and  cold  air,  and  the  grinders, 
millers  and  stone-cutters. 

3.  Obstruction  to  the  current  of  the  blood  through  the  great  branches 
of  the  aorta  below  the  origin  of  the  bronchial  arteries,  such  as  may  be 
caused  by  abdominal  drojisy,  accumulation  of  gas,  or  of  refuse  matter  in 
the  intestines. 

4.  As  a  result  of  morbid  states  of  the  blood,  as  seen  when  bronchial 
catarrh  is  a  premonitory  symptom  of  typhoid  fever,  measles  and  small-pox. 

Symptoms. — The  general  symptoms  of  a  common  cold  on  the  breast 
are  so  well  known  to  every  one  that  it  is  not  worth  while  to  occupy  space 
in  describing  them,  and  yet,  frequent  as  is  popular  acquaintance  with  this 
disease,  few  persons  realize  the  terrible  dangers  which  attend  upon  a 
neglected  cough. 

Treatment — 1.   The  most  important  thing  in  relation  to  this  malady 


COMMON  COUGH  OR  BRONCHIAL  CATARRH.  531 

is  to  prevent  its  occurrence.  This  could  probably  be  accomplisbed  in  four 
cases  out  of  five  by  the  exercise  of  a  troublesome  amount  of  prudence, 
which,  however,  would  be  well  expended  were  young  peopl«  willing  to 
make  the  effort  to  escape  this  frequent  cause  of  early  death.  "When,  how- 
ever, a  person  is  unfortunate  enough  to  contract  a  cough  by  his  own  im- 
prudence or  otherwise,  it  may  often  be  cut  short  by  bringing  on  a  free 
perspiration.  A  good  way  to  accomplish  this  is  to  take  a  hot  mustard  foot- 
bath and  ten  grains  of  Dover's  powder  on  retiring  for  the  night,  wrapping 
the  throat  up  in  flannel  if  it  feels  sore,  and  being  very  careful  not  to  undo, 
and  more  than  undo,  the  beneficial  work  of  this  treatment  by  uncovering 
oneself  in  the  night,  or  by  imprudent  exposure  the  next  day. 

2.  If  this  method  is  not  resorted  to  early  enough,  or  if  it  fails  and 
the  cough  goes  on  unchecked,  ten-drop  doses  four  times  a  day  of  anti- 
monial,  or  ipecacuanha  wine,  and  nitrate  of  potash,  or  muriate  of  am- 
monia in  quantities  of  five  grains  every  three  or  four  hours,  are  generally 
useful. 

3.  By  the  third  or  fourth  day  great  advantage  may  be  derived  from 
the  use  of  a  mixture  of  half  a  teaspoonful  each  of  syrup  of  squills  and 
syrup  of  wild  cherry  with  one-twelfth  grain  of  cyanide  of  potassium  every 
six  hours.  If  this  remedy  agrees  with  the  patient  it  may  be  taken  more 
frequently  or  in  sufficient  doses  to  quiet  the  cough  through  the  night,  but 
it  must  be  used  with  great  caution,  as  it  contains  ingredients  which  are 
poisonous  in  over-doses,  or  ammonia  chloride,  1^  drachms;  Brown's  mix- 
ture, 4  ounces.     One  to  two  teaspoonfuls  every  three  hours. 

4.  Should  the  disease  persist  notwithstanding  the  employment  of 
these  various  medicines,  counter-irritation  with  croton  oil  and  tincture  of 
iodine  applied  to  small  spots  on  the  upper  part  of  the  chest  in  front,  or 
croton  oil  alone  rubbed  on  the  back,  also  with  great  caution,  should  be  re- 
sorted to  without  that  further  delay  during  which  the  catarrhal  irritation 
of  the  bronchial  tubes  might  become  clironic,  as  it  is  commonly  phrased, 
and  the  cough  get  such  a  hold  that  it  cannot  be  shaken  off. 

Auxiliary  Treatment — A  very  important  part  of  the  treatment  is  the 
breathing  of  a  continuously  warm,  moist  atmosphere,  and  for  children 
especially,  the  prescription  of  one  warm  room  is  probably  more  conducive 
to  recovery  than  any  one  of  the  medicines  suggested.  Particularly  ought 
young  children,  in  Avhom  previous  experience  lias  shown  there  exists  any 
tendency  to  croup,  to  be  guarded  against  the  development  of  that  dan- 
gerous affection  by  even  the  slight  additional  exposure  of  passing  through 


532  DISEASKS   OF  THE  KESPIRATORY   SYSTEM. 

a  cool  entry  to  their  im>als.  At  the  same  time  the  apartment  to  which  the 
invalid  is  coniined  must  not  be  kept  too  warm,  and  due  attention  should 
be  paid  to  its  proper  ventilation. 

BKONCHITIS, 

Character — This  disease,  an  inflammation  of  the  bronchial  tubes,  or 
air-passages  leading  to  the  pulmonary  vesicles,  is  characterized  by  hoarse- 
ness and  moderate  cough,  with  heat  and  soreness  of  the  chest  in  front,  all 
these  being  more  or  less  intense  according  to  the  severity  of  the  attack. 
In  every  common  cough  there  is  always  some  bronchitis,  but  the  element 
of  danger  lies  in  the  extension  of  the  inflammatory  action  to  the  smaller 
bronchial  tubes  or  bronchioles,  and  the  approximation  consequently  to 
that  fatal  form  of  the  malady  termed  capillary  bronchitis. 

Simple  Bronchitis  Symptoms. — Simple  bronchitis  is  usually  ushered  in 
with  a  slight  chilliness,  general  discomfort,  and  some  febrile  disturbance. 
A  sense  of  constriction  about  the  chest  and  some  deep-seated  soreness 
beneath  the  breast  bone  soon  follow.  The  respiration  is  slightly  increased 
in  frequency,  but  no  urgent  dyspnoea  is  generally  present,  unless  the 
patient  is  a  suflFeror  from  some  chronic  affectioH  of  the  heart  or  lungs,  as, 
for  examjile,  valvular  disease  of  the  former  organ.  Cough  is  uniformly 
present  in  bronchitis,  is  worse  after  sleep,  and,  as  a  rule,  paroxysmal.  The 
expectoration  is  at  first  scanty  and  viscid,  but  soon  becomes  more  abxmdant, 
white  and  frothy,  and  still  later  yellowish  or  muco-purulent.  In  this 
latter  stage  the  cough  is  looser,  less  painful,  and  the  phlegm  is  expec- 
torated more  easily. 

Capillary  Bronchitis  Symptoms. — Capillary  bronchitis  usually  develops 
out  of  the  sim]ile  form,  and  therefore  its  onset  can  hardly  be  said  to  be 
characterized  by  any  well-marked  symptoms.  Occasionally,  however,  a 
sharp  chill  defines  the  date  of  its  attack.  When  developed,  the  patient 
breathes  with  difficulty,  the. complexion  is  dusky,  and  the  countenance  be- 
trays anxiety.  The  superficial  veins  are  over-filled,  as  a  consequence  of 
the  obstruction  to  the  pulmonic  circulation,  and  the  movements  of  the 
sides  of  the  nostrils  are  exaggerated.  The  respiration  and  pulse  are  quick- 
ened, the  former  very  much  so,  and  out  of  proportion  to  the  latter.  The 
cough  is  almost  constant,  and  the  expectoration,  at  first  frothy,  and  after  a 
time  yellowish,  is  expelled  with  considerable  difficulty.  Troublesome 
pains  in  the  intercostal  muscles,  brought  on  liy  the  unremiftin"^  exertion  of 
coughing,  are  of  frequent  occurrence,  the  temperature  rises  to  a  consider- 


BKuJvcinTis.  533 

able  elevation,  and  the  restlessness  is  extreme ;  the  renal  excretion  is  scanty, 
and  sometimes  a  little  albuminous.  In  fatal  cases  the  prostration  becomes 
intense,  the  skin  livid,  cold  and  clanuny.  Dropsy  of  the  feet  and  legs  may 
come  on,  and  at  last  fitful  drowsiness  or  muttering  delirium  precede  coma 
and  death. 

Acute  Bronchitis  Diagnosis — The  diagnosis  of  acute  bronchitis  is  or- 
dinarily not  difficult.  Capillary  bronchitis  must  be  distinguished  from 
pneumonia,  which  can  generally  be  done  by  the  greater  amount  of  fever 
and  disturbance  of  the  respiration  as  well  as  the  dullness  on  percussion, 
tubular  breathing,  and  irregular  distribution  over  the  chest  of  the  latter 
affection.  In  acute  tuberculosis,  or  galloping  consumption,  the  violence 
and  irregularity  of  the  fever,  the  rapid  collapse  of  strength,  and  the  ex- 
treme dyspnoea,  out  of  all  proportion  to  the  physical  signs,  indicate  the 
nature  of  the  case  in  most  instances. 

Treatment — 1.  A  threatened  attack  of  bronchitis  may  sometimes  ap- 
parently be  cut  short  by  a  hot  foot-bath  and  dose  of  Dover's  powder,  as 
already  suggested,  and  a  full  dose  of  ten  grains  of  salicin  or  of  quinine 
will  perhaps  aid  the  good  work  of  this  treatment. 

2.  After  the  disease  is  fully  developed  the  remedies  are  chiefly  pal- 
liative, and  consist  of  opiates,  such  as  morphia,  belladonna,  or  preferably, 
in  many  cases  codeia,  in  half-grain  doses,  to  quiet  the  cough  and  promote 
the  expectoration.  The  softening  of  the  secretion,  and  easing  of  the  inces- 
sant cough,  are  also  promoted  by  keeping  the  patient  in  a  moist  atmos- 
phere, as  suggested  in  regard  to  croup. 

3.  Pain  in  the  chest  can  often  be  relieved  by  mustard-plasters  and 
stimulating  liniments,  or  painting  with  tincture  of  iodine.  Half  tea- 
spoonful  doses  of  the  syrups  of  squills,  ipecacuanha  and  lobelia,  every 
two,  three  or  four  hours,  according  to  the  urgency  of  the  symptoms,  are 
probably  useful,  and  the  iodide  of  potassium,  in  five-grain  doses,  if  well 
borne  by  the  patient  without  irritating  the  mucous  membranes  of  the  eyes 
and  throat,  as  it  sometimes  does  in  a  singular  way,  is  highly  recommended. 

Diet — There  is  no  need  of  restricting  the  diet  in  this  disease,  and 
any  wholesome  food  which  the  patient  craves  may  be  allowed.  In  the 
treatment  of  the  capillary  bronchitis  of  young  children  it  is  necessary  to 
use  opiates  with  much  greater  caution,  and  the  occasional  administration 
of  an  emetic,  to  aid  in  clearing  out  the  accumulated  niueus,  is  important. 
Counter-irritation  by  mustard  or  turpentine  may  be  tried,  and  dry  cup- 
ping often  gives  great  relief. 

Chronic  Bronchitis. — Chronic  bronchitis   is   a  very  common   malady, 


534  DISEASES  OF  THE  EESPIEATOBY  SYSTEM. 

its  frequency  increasing  with  the  coming  on  of  old  age.  It  may  be  chronic 
from  the  outset,  or  be  the  result  of  the  acute  form.  Chronic  limg  diseases 
generally  are  apt  to  lead  to  it,  and  so  does  the  abuse  of  alcohol. 

Treatment. — Chronic  bronchitis,  especially  when  in  the  form  called 
dry  catarrh,  is  often  relieved  by  iodide  of  potassium  and  colchicum. 

PNEUMONIA  OR  INTLAMMATION  OF  THE  LITNGS. 

Causes. — This  disease,  called  also  lung  fever,  is  the  most  serious  of 
the  common  acute  diseases  of  the  pulmonary  organs.  Long  continued 
exposure  to  cold  is  apt  to  be  the  exciting  cause  of  pneumonia;  but  there 
are  some  reasons  for  supposing  that  it  is,  at  least  in  many  instances,  a 
local  manifestation  of  a  general  disease,  perhaps  contagious  in  its  char- 
acter. It  often  comes  on  in  the  course  of  other  grave  maladies  and  adds 
very  much  to  their  fatality. 

The  Stages. — The  three  stages  through  which  this  complaint  passes 
in  typical  cases,  are,  first,  that  of  congestion,  where  the  lung  is  engorged 
with  blood;  second,  that  of  red-hcpatization,  in  which  the  inflamed  lung 
is  dark  red  and  solid  like  a  piece  of  liver,  sinking  in  water  and  breaking 
down  readily  imder  the  pressure  of  the  finger;  and,  third,  the  stage  of 
grey-hepatizatlon,  in  which  the  affected  pulmonary  tissue  is  still  dense, 
but  of  a  yellowish-grey  color. 

Symptoms. — 1.  The  symptoms  of  an  ordinary  attack  of  pneumonia, 
coming  on  from  exposure  to  cold,  in  a  robust  adult,  are  quite  character- 
istic. The  disease  usually  sets  in  with  a  single  severe  and  prolonged  chill, 
after  which  the  temperature  of  the  body  rapidly  rises  to  a  high  point  and 
this  rise  is  accompanied  by  the  customary  symptoms  of  fever.  Pain  is 
commonly  felt  about  the  region  of  the  nipple  on  the  affected  side  and  is 
sharp,  stabbing  and  aggravated  by  movement  in  breathing  or  otherwise, 
and  also  by  pressure. 

2.  There  is,  likewise,  well-marked  dyspnoea,  characterized  by  ex- 
tremely frequent,  shallow  breathing,  quite  different  from  the  kind  of 
dyspncea  observed  in  bronchitis  and  in  asthma;  the  rapidity  of  respira- 
tion ranges  from  twice  to  four  times  the  frequency  of  health;  that  is,  from 
about  thirty  to  sixty  per  minute;  and  this  increase  in  the  number  of  the 
respiratory  efforts  is  partly  due  to  fever,  partly  to  impurity  of  the  blood 
and  partly  to  the  pain  which  prevents  drawing  a  full  breath.  The  sides 
of  the  nostrils  are  commonly  in  active  movement  at  every  inspiration. 

3.  The  third  prominent  symptom  is  cough,  generally  frequent,  hack-. 


Consumption;     Interveslcular    changes. 


Fl£.    1. — Pleuropneumonia. 


■-\     /-■•.,  ^-..;^ -- 


v^rr 


Pig-.  3.^ — Surface  of  the  breast  in  a  normal  condition;  con- 
tours of  cardial  torpor  to  the  left  of  the  ImomsI  l»one.  Tho  Fig.  4. — Croupo-is  or  v  sIchI.t 
spaces  included  In  the  dotted  lines  reiirc^f^n;  ih«'  intcnnediati-  pnoLinonla-  Estate  of  consolldu 
spaces.                                                                                                                                             lion. 

THE  LUNGS  AND  THEIR  DISEASES 
635 


536  DISEASES    OK    TlIK    KESIMHATOHV    SVSl'K.M. 

ing  aud  constrained  on  aecount  of  the  suffering  which  it  causes.  It  is 
dry  at  first,  but  on  the  second  or  third  day  the  patient  commences  to 
bring  up  at  each  paroxysm  of  cough,  some  of  the  peculiar,  viscid  material 
of  exactly  the  color  of  rusty  iron.  This  expectoration  does  not  occur  in 
young  children,  is  often  absent  in  secondary  pneumonia  and  in  the  pneu- 
monia of  the  aged.  The  fever  usiially  attains  its  height  on  the  second  or 
third  day. 

4.  The  pulse  is  usually  strong  and  full  at  the  outset,  but  later  on  in 
the  attack  it  becomes  small  and  weak,  partly  as  a  result  of  the  imperfect 
filling  of  the  arteries  from  obstruction  of  the  pulmonary  circulation  and 
partly  from  cardiac  feebleness.  The  cheeks  are  fliished  to  a  very  marked 
degree  and  an  eruption  of  little  blisters,  a  variety  of  herpes,  is  sometimes 
present  upon  the  lips,  which  are  of  a  dusky  hue.  Prostration,  feebleness, 
headache,  restlessness  and  delirium  at  night  are  common.  The  tongue  is 
dry  and  coated,  the  thirst  is  eager,  but  the  appetite  for  food  is  lost  and 
the  bowels  are  costive. 

5.  In  favorable  cases,  these  symptoms  which  have  been  detailed 
gradually  increase  up  to  the  fifth,  sixth,  or  seventh  day  and  may  then 
rapidly  subside,  the  temperature  falling  to  the  natural  standard  two  or 
three  days  later,  and  the  solidified  portions  of  the  hmg  clearing  out  occa- 
sionally with  wonderful  celerity.  The  cough  and  dyspnoea  speedily  abate, 
and  the  sputum  becomes  yellow  and  muco-purulent.  When  the  malady 
ends  fatally,  death  usually  occurs  about  the  end  of  the  first  or  early  in 
the  second  week,  and  results  from  failure  of  the  action  of  the  heart,  or 
else  from  pulmonary  embarrassment. 

Treatment — 1.  There  is  no  doubt  that  the  intense  pain  accompanying 
the  onset  of  pneTimonia  can  be  promptly  relieved  by  blood-letting;  but 
since  the  tendency  of  the  disease  is  toward  death  by  debility  and  it  is  im- 
possible to  say  in  any  given  case  how  far  over  the  pulmonary  structure  the 
inflammation  will  extend,  we  can  never  feel  sure  that  the  loss  of  the  vital 
fluid  abstracted  will  be  safely  borne  by  the  patient.  In  very  robust  per- 
sons, in  the  prime  of  life,  it  is  proper  to  bleed;  becaiise  the  chance  of  dim- 
inishing the  violence  of  the  attack  thereby  is  at  least  equal  to  the  danger 
of  seriously  decreasing  the  strength.  In  less  vigorous  individuals,  leech- 
ing or  cut-cupping,  and  in  patients  of  feeble  constitutions,  dry-cupping 
will  generally  afford  considerable  relief. 

2.  Large  doses  of  quinine,  even  as  much  as  twenty  or  tw^enty-five 
grains,  may  be  given  at  the  first  onset,  in  the  hope  of  cutting  sliort  the 
disease  and  later  on  for  the  purpo^'e  '  f  reducing  tlis  fever,  wliich  in  itself 


EMl'llYSEMA. 


58T 


is  a  great  cause  of  danger,  as  already  explained.  Opiates  in  the  form  of 
Dover's  powder,  tlie  hypodermic  injection  of  morphia,  or  of  codeia  in 
half-grain  doses,  M^hen  the  latter  medicine  siiits  the  patient,  are  of  great 
service  in  diminishing  suffering,  jirocuring  sleep  and  allaying  cough. 

3.  Toward  the  latter  part  of  a  severe  attack  the  chief  treatment  is 
that  of  nutrition  and  stimulation,  and  as  there  is  often  in  this  disease  a 
great  tolerance  by  the  nervous  system  of  alcohol,  such  as  we  see  in  typhoid 
fc\cr,  immense  amounts  of  milk-punch,  or  diluted  brandy  and  whiskey, 
are  sometimes  consumed  with  apparent  benefit.  Alcoholic  stimulants 
.sliould  never  be  given  to  the  extent  of  producing  symptoms  of  intoxica- 
tion, but  short  of  this  point  they  are  of  great  service  in  keeping  up  the 
action  of  the  heart  and  thus  preventing  the  fatal  eifect  of  cardiac  failure. 

4.  Since  the  immediate  cause  of  death  in  many  examples  of  fatal 
pneumonia  is  the  over-distension  of  the  right  side  of  the  heart,  with  conse- 
quent separation  of  fibrin  in  the  partially  stagnating  blood  constituting 
heart-clot,  it  is  advisable  to  diminish  this  tendency  to  coagailation  of  the 
blood  in  the  heart  and  the  production  of  a  thrombus  by  the  administra- 
tion of  five  grains  of  carbonate  of  anunonia  every  three  or  four  hours, 
wdiich,  however,  ought  not  to  be  continued  for  more  than  a  day  or  two. 

Diet During  convalescence  from  inflammation  of  the  lungs  danger 

from  relapse  is  not  nearly  so  great  as  in  many  other  maladies,  such,  for 
exanqjle,  as  diphtheria,  and  hence  free  indulgence  of  the  appetite  for  all 
wholesome  food  and  out-door  exercise,  as  soon  a§  the  strength  permits, 
uiay  be  allowed. 

EMPHYSEMA  (LUNG  DISTENSION). 

Varieties — The  two  varieties  of  emphysema  are,  first,  the  vesicular, 
m  whicli  tlie  vesicles  are  distended  and  dilated,  and  the  interlobular,  in 
which  the  air  has  escaped  from  the  air-cells  in  consequence  of  their 
rupture,  and  diffused  itself  through  the  connective  tissue  of  the  pulmonary 
substance.  This  condition  is  commonly  the  result  of  accidents  leading  to 
great  straining  in  the  respiratory  muscles,  as  in  the  violent  jiaroxysms  of 
whooping-cough  and  of  asthma,  and  men  or  animals  who  are  the  subjects 
of  emphysema  are  popularly  and  very  accurately  described  as  "broken 
winded." 

Symptoms. — The  symptoms  of  emj^hysema  are  in  direct  proportion  to 
the  amount  of  lung-tissue  affected,  and  consist  of  dyspnoea  which  re- 
sembles that  of  asthma  ;ind  is  unlike  tliat  of  vahnilar  disease  of  the  heart 
in  being  esjieeially   marked   during  the   effort   at   expiration.      Coiigh   is 


j538  DISEASES  OF  THE  EESPIEATOEY  SYSTEM. 

usually  present,  but  is  not  attended  with  expectoration,  unless  the  disease 
is  complicated  •with  chronic  bronchitis,  as  is  frequently  the  case.  In  bad 
oases  of  emphysema  the  interference  with  the  aeration  of  the  blood  is  so 
great  that  the  complexion  is  dusky  and  the  patient  languid  and  dull. 

Treatment. — The  treatment  of  this  disease  is  limited  to  palliating  the 
symptoms  as  much  as  possible,  and  remedying  the  maladies,  such  as 
chronic  bronchitis  or  asthma,  with  which  it  is  frequently  complicated. 
Anodynes,  which  apjDcar  urgently  called  for  to  relieve  the  pain  and  dis- 
tress must  be  employed  with  caution  on  account  of  the  imperfect  aeration 
of  the  blood,  which  is  already  an  element  of  danger.  Dry  cupping  be- 
tween the  shoulders  is  often  of  service,  and  the  use  of  quinine,  iron  and 
strychnia,  as  directed  in  anemia,  is  beneficial  by  improving  the  general 
health.  Change  of  residence  to  a  warmer  and  more  equitable  climate  than 
that  of  the  northern  United  States  is  probably  the  best  remedy  we  can 
urge  upon  patients  afflicted  with  enqjhysema. 

TTIBERCTILOSIS, 

How  We  Get  Tuberculosis. — We  can  get  tuberculosis  only  by  receiving 
into  the  body  the  little  germs  known  as  the  tubercle  bacilli.  The  consump- 
tive infects  another,  or  gives  tuberculosis  of  the  lungs  to  another,  by 
means  of  the  tubercle  bacilli  in  the  material  coughed  up  from  the  diseased 
lungs,  which  often  contains  millions  of  these  germs.  The  germs  get  out 
of  the  body  of  a  person  who  has  tuberculosis,  not  only  in  the  material 
which  is  coughed  up,  but  also  in  the  little  drops,  too  small  to  be  seen, 
which  are  sprayed  out  when  persons  with  tuberculosis  cough  or  sneeze. 

Great  care  should  be  taken  to  destroy  all  material  coughed  up  by 
the  consumptive,  and  to  avoid  careless  covighing  and  sneezing.  If  this  is 
not  done,  and  the  sputiim  is  discharged  on  the  floor  or  carpets  or  clothing, 
the  germs  may  live  for  months,  especially  in  dark,  damp,  unventilated 
bedrooms,  living  rooms,  and  workrooms. 

The  germs  will  live  in  the  darkness  and  dampness  for  a  long  time, 
and  are  stirred  up  in  dusting  and  sweeping  these  rooms,  and  float  in  the 
air  and  may  be  breathed  into  the  lungs,  or  may  fall  upon^articles  of  food 
and  be  taken  into  the  body  in  that  way. 

The  disease  is  often  called  CONSUMPTION',  for  the  reason  that 
during  its  progress  the  patient  loses  weight  rapidly,  and  hence  seems  to  be 
consumed.  Tuberculosis  may  infect  any  other  part  of  the  body  besides 
the  lungs,  such  as  the  bones,  joints,  intestines,  glands,  brain,  spinal  cord, 


TUBERCULOSIS.  539; 

and  tlie  skin,  but  of  all  forms  of  inflammation,  that  of  the  lungs  is  most 
common.  The  tuhercle  hacUlus  is  the  only  cause  of  the  disease.  Tweuty- 
five  hundred  of  these  germs  placed  end  to  end  would  not  be  one  inch  in 
length.  These  germs  may  gradually  spread  through  the  greater  part  of 
one  or  both  lungs,  destroying  tlie  usefulness  of  those  organs  until  finally 
the  patient  dies  of  the  disease. 

Many  people  tliink  that  pulmonary  tuberculosis  comes  from  a  cold 
or  some  other  disease,  or  is  inherited.  This  is  not  correct.  The  reason 
■why  people  develop  tuberculosis  after  a  prolonged  cold  or  pneumonia  or 
other  exhausting  disease  is  because  their  systems  have  run  down  to  such 
an  extent  that  they  are  not  strong  enough  to  resist  the  tubercle  bacilli 
when  taken  into  their  bodies.  These  germs  are  widely  distributed,  and 
practically  all  people  breathe  them  in  at  times.  If  their  systems  are  in 
excellent  condition,  the  germs  do  not  gain  a  foothold  and  start  the  disease. 
Any  condition  that  weakens  the  body  predisposes  one  to  consumption. 

Symptoms — There  are  a  number  of  symptoms  which  might  lead 
a  person  to  suspect  that  he  has  pulmonary  tuberculosis,  namely:  loss  of 
weight,  loss  of  appetite,  loss  of  color,  fever  in  the  afternoon,  cough  and 
expectoration  lasting  for  several  weeks,  spitting  of  blood  or  streaks  of 
hlood  in  the  sputum,  chills,  night  sweats,  difficulty  in  breathing,  and  pains 
in  the  chest. 

In  incipient  tuberculosis  the  commonest  symptoms  are  loss  of  weight 
with  cough  and  expectoration.  When  these  symiDtoras  occur  it  does  not 
necessarily  mean  that  tuberculosis  exists,  but  it  would  be  wise  for  a  person 
Laving  them  to  consult  a  physician. 

Medicines — There  is  no  medicine  that  will  cure  consumption.  It 
is  a  waste  of  time  and  money  to  use  so-called  "Consumptive  Cures."  All 
advertised  cures  of  this  nature  are  frauds.  Doctors  who  advertise  should 
loe  avoided  as  much  as  medicines  which  are  advertised.  Reputable  doctora 
do  not  advertise. 

Treatment — The  treatment  for  tuberculosis  is  rest,  with  plenty  of 
fresh  air,  and  enough  good  wholesome  food.  No  medicine  is  necessary 
except  in  cases  where  other  diseases  are  present.  The  disease  may  bo 
cured  at  home  in  many  instances  if  it  is  recognized  early,  and  proper 
means  are  taken  for  its  treatment.  Wlien  a  number  of  a  family  is  found 
to  have  consumption  and  cannot  be  sent  to  a  sanatorium,  arrangements 
for  taking  the  cure  at  home  should  be  made  as  soon  as  the  disease  ia 
discovered. 

It  is  important,  iu  the  treatment  of  tuberculosis,  to  breathe  air  that 


540  BISEASES    Oh'     TIIM    HKSl'II;  \  I'OIJY    KYSTKM. 

is  fresh  and  pure,  to  eat  an  abundance  of  good  food,  to  stop  heavy  work 
and  ■worry,  and  to  take  a  bodily  and  mental  rest  by  lying  down  before  and 
after  the  noon  and  evening  meals.  To  obtain  the  first,  the  patient  must  live 
out  of  doors.  This  means  that  as  many  hours  of  the  day  and  night  as 
possibla  should  be  spent  in  the  open  air,  and  in  order  to  carry  out  this 
treatment  some  place  must  be  provided  which  is  not  only  protected  from 
wind,  but  also  from  rain  and  snow,  as  nothing  except  the  most  severe  cold 
weather  shoxild  prevent  the  patient  from  living  and  sleeping  there.  The 
outdoor  shelter  shoulil  be  large  enough  for  a  bed,  a  reclining  chair,  and 
a  table.  It  should  overlook  ])](>asant  and  sanitary  surroundings  if  possible, 
as  it  is  to  be  the  home  of  the  patient  for  months,  and  will  give  better 
results  if  comfortable  and  attractive. 

Tenement  house  dwellers  and  persons  living  in  apartment  houses  in 
large  cities  sliould  make  every  effort  possible  to  give  the  open  air  treatment 
to  a  member  of  the  family  who  contracts  tuberculosis.  First,  consider  the 
possibility  of  moving  into  the  suburbs  or  nearby  small  towns.  If  this 
cannot  be  done,  try  to  obtain  from  the  landlord  the  use  of  the  roof,  and 
build  a  small  shack  there.  If  this  is  beyond  the  means  of  the  family,  use 
one  room  Avith  a  window  opening  on  the  street  or  large  court  for  the 
patient,  and  then  place  the  head  of  the  bed  beside  the  window  and  cover 
it  with  a  window  tent.  The  cost  of  a  window  tent  is  about  $10,  and  if  it 
cannot  be  obtained,  take  two  large  heavy  cotton  sheets,  sew  them  together 
along  the  edge,  tack  one  end  of  the  double  sheet  to  the  top  of  the  window 
casing  and  drop  the  lower  end  over  the  outer  side  of  the  bed,  fastening 
the  bottom  of  the  sheet  to  the  bedrail  with  tape.  There  will  be  enough 
cloth  hanging  on  each  side  of  the  window  to  form  the  sides  of  the  tent, 
and  these  should  be  fastened  to  the  window  casings.  A  window  tent 
can  be  made  at  home  for  about  $3  by  using  12  or  15  yards  of  heavy  denim 
or  light  canvas.  One  straight  jiiece  of  denim  should  be  hung  from  the 
top  of  the  window  casing  to  the  outer  side  of  the  bed,  and  the  openings 
between  this  and  the  side  window  casings  filled  in  with  sides  cut  and 
fitted  from  the  balance  of  the  cloth.  By  these  methods  the  patient  gets 
fresh  air  from  tlie  Avindow  and  the  room  is  kept  warm  in  cold  weather 
as  a  place  for  dressing  and  toilet  purposes.  During  mild  and  warm 
weather  the  tent  can  be  removed  and  the  window  kept  open  both  at  top 
and  bottom. 

How  to  Arrange  a  Porch. — If  tlie  family  lives  in  a  small  town  or  in 
the  country,  it  will  usually  be  found  that  a  norch  is  the  most  convenient 
way  of  providing  open-air  quarters.      Tn  selectiiiir  a   site  for  the  porch. 


IDBEKCULOSIS.  541 

it  is  well  to  reniiMnlicr  that  the  patient  should  be  j)lacc(I  out  of  doors 
111  sufh  a  way  that  the  cuic  can  be  taken  with  comfort  at  all  seasons  of  the 
year.  For  the  winter  months  the  best  place  is  on  the  south  side  of  the 
house,  as  there  will  be  found  the  greatest  amount  of  sunshine.  If  this 
cannot  be  done,  choose  first  the  east,  or  second  the  west  side,  but  not  the 
north  side  except  as  a  last  resort,  for  it  is  a  windy  and  cold  position  in 
winter.  The  back  of  the  house  is  usually  better  than  at  the  front,  if  the 
porch  cannot  be  seen  from  the  street.  Tlte  most  important  thing  is  to  find 
a  sheltered  spot,  for  luind  is  much  harder  to  hear  than  intense  cold.  If 
the  house  has  permanent  verandas,  and  you  cannot  afford  a  special  porch, 
use  a  veranda,  and  obtain  privacy  by  putting  up  canvas  curtains  or  bam- 
boo screens. 

How  to  Build  a  Cheap  Porch — A  useful  porcli  can  bo  built  for  $12 
or  $15  with  cheap  or  second-hand  lumber,  and  if  only  large  enough  to 
receive  the  bed  and  a  chair  will  still  be  effective  for  the  outdoor  treatment. 
The  roof  can  be  made  with  a  canvas  curtain  or  a  few  boards  and  some  tar 
pajier.  The  end  most  exposed  to  the  wind  and  rain  and  the  sides  below 
the  railing  should  be  tightly  boarded  to  prevent  draughts.  A  window  can 
be  used  for  the  approach,  but  it  will  be  more  convenient  if  it  is  cut  down 
to  the  floor  and  a  small  Dutch  door  put  in  below  the  window  sash.  Second 
and  third  story  porches  are  supported  from  the  ground  by  long  4  by  4: 
posts,  or,  when  small,  they  can  be  held  by  braces  set  at  an  angle  from 
the  side  of  the  house. 

Bed  and  Bedding  for  Outdoor  Sleeping — An  ordinary  iron  bedstead 
with  woven  wire  spring  3  feet  G  inches  wide  and  a  moderately  thick 
mattress  are  all  that  are  necessary  except  for  cold  weather.  A  good 
hair  mattress  is  best,  but  when  this  cannot  be  obtained,  a  cotton-felt 
mattress  can  be  bought  for  $4,  or  a  wool  mattress  for  about  $10.  Over 
the  mattress  ]ilace  an  old  blanket  or  a  cotton  bed-pad,  the  same  width  as 
the  mattress,  and  on  this  the  ordinary  bed  sheets  or  blanket-sheets.  For 
those  who  like  heavy  bed  covering  as  many  blankets  as  desired  may  be 
used.  Those  who  prefer  light  covering  can  use  do^vn  comforts,  or  lamb's 
wool  or  cotton-filled  comforts,  or  the  material  for  wool  or  cotton  quilts 
can  be  obtained  for  about  $2  and  warm  covering  made  at  home.  Very 
cheap,  light,  but  waiiu  covering  can  be  made  by  using  paper  blankets 
placed  between  two  thicknesses  of  outing  flannel  or  bed  covers.  These 
paper  blankets  are  sold  for  fifty  cents  each  and  wear  for  about  six  months. 
A  woolen  horse  blanket  with  an  oiilsiilc  «(  canvas  can  be  used  as  a 
covering  to  protect  the  bediliiig  in  \',(  t  niid  slormy  weather. 


542  DISEASES  OF  THE  EESPIEATORY  SYSTEM. 

Sleeping-Bags. — In  very  severe  weather  a  sleeping  bag  may  be  used, 
and  this  is  made  by  sewing  blankets  together  around  the  edges,  leaving 
the  top  open,  using  as  many  layers  as  desired.  The  blankets  should  be 
7  feet  long  by  4  feet  wide. 

Arrangement  of  Pillows — Place  two  pillows  in  form  of  an  Inverted  V, 
with  the  apex  at  the  top  of  the  bed  and  the  head  at  the  point  where  the 
two  pillows  meet.  This  position  allows  the  shoulders  to  nestle  between 
the  pillows  and  protects  them  from  the  cold  wind. 

How  to  Prepare  the  Patient  for  the  Night — In  cold  weather  the  out- 
door sleeper  should  get  into  the  bed  in  a  warm  room  and  have  some  one 
roll  him  out  of  doors.  If  this  is  impossible,  use  a  warm  dressing-gown 
in  going  back  and  forth  from  the  dressing  room  to  the  porch,  and  warm 
the  bed  by  placing  in  it  for  a  few  minutes  before  retiring  a  hot  water 
bag,  hot  bricks,  soapstoncs  or  bottles  filled  with  hot  water.  In  some 
cases  it  is  well  to  leave  a  hot  stone  or  bottle  wrapped  in  flannel  at  one 
corner  of  the  bed,  where  it  will  throw  off  heat  slowly  during  the  night. 

All  covers  except  the  top  blanket  or  comfort  should  be  tucked  in 
under  the  bed-pad.  The  topmost  cover  is  then  tucked  under  the  mattress 
to  keep  the  under  covers  from  sliding  off  when  the  sleeper  is  restless. 

Clothing  Worn  at  Night — A  woolen  undershirt,  a  sweater  and  a 
long  outing  flannel  nightgown  or  bathrobe  are  iisually  worn,  but  in  very 
cold  weather  some  patients  wear  a  jiair  of  drawers  made  of  flannel,  a 
pair  of  bed-socks  or  knitted  slippers,  and  a  woolen  abdominal  bandage. 
Never  cover  the  head  wilh  the  hedclothes.  The  patient  can  wear  a  knitted 
skull-cap  long  enough  to  be  pulled  down  to  the  end  of  the  nose  and  over 
the  ears,  or  a  knitted  helmet  which  covers  the  whole  of  the  head,  face  and 
Ticck,  with  the  exception  of  a  small  opening  for  the  nose  and  mouth.  Care 
slioTild  be  taken  not  to  interfere  with  the  inhaling  air  or  to  allow  the 
breath  as  it  is  exj^elled  from  the  nose  or  mouth  to  come  in  contact  with 
the  cloth  and  fonn  icicles.  Chapping  of  the  face  during  the  night  can  be 
prevented  by  using  cold  cream  or  vaseline  aboiit  the  nose  and  lips. 

General  Directions — Eest  is  a  most  important  part  of  the  open  air 
treatment,  and  exercise  must  be  regulated  by  the  doctor.  Always  have  at 
hand  an  extra  wrap,  and  never  remain  out  if  chilled.  Cold  weather 
should  have  a  bracing  effect,  and  when  it  does  not,  go  into  a  warm  room 
and  get  a  hot  drink,  preferably  milk,  remaining  indoors  until  comfortably 
warm.  AYhen  going  out  again  use  more  wraps  and  keep  behind  a  shield 
or  screen  that  breaks  the  force  of  tlic  wind.  Always  be  cheerfiil  and 
hopeful  -.  never  waste  your  strength  in  anger  or  being  cross.  Lead  a 
temperate  life,  go  to  bed  early  and  get  up  late;  do  not  use  alcohol  in 


CONSUMPTION.  543 

any  form  except  when  prescribed  by  jonv  doctor.  Do  away  with  tobacco 
if  jiossible,  and  use  only  weak  tea  and  coffee  in  small  quantities.  Never 
swallow  the  matter  coughed  up,  but  always  destroy  every  particle  by 
spitting  in  a  paper  or  cloth  which  can  be  burned.  Never  allow  the  hands, 
face,  or  clothing  to  be  soiled  by  sputum,  and  if  this  happens  by  accident, 
wash  the  place  soiled  with  soap  and  hot  water.  Men  who  have  consump- 
tion should  not  wear  a  mustache  or  beard,  unless  it  is  trimmed  close. 
Particidar  care  must  be  taken,  when  sneezing  and  coughing,  to  hold  in 
the  hands  before  the  face  a  cloth  which  can  be  burned.  Soiled  bed-clothes, 
night-dresses,  other  washable  garments  and  personal  linen  should  be 
handled  as  little  as  possible  until  they  are  boiled  prior  to  their  being 
washed.     The  dishes  used  by  the  patient  miist  be  boiled  after  each  meal. 

All  this  means  care  and  work,  but  must  be  done  both  as  a  protection 
to  the  household  and  in  order  to  bring  about  a  speedy  cure  for  the  patient. 

Deep  or  full  breathing  is  especially  recommended  to  those  who  have 
consumption  or  any  weakness  of  the  lungs.     See  article  on  deep  breathing. 

CONSUMPTION  OR  PULMONARY  PHTHISIS. 

Character. — Tubercular  jjlithisis  or  true  pulmonary  consumption  is 
that  form  in  which  the  peciiliar  tubercular  matter  is  deposited  in  the  lungs 
in  small  masses  or  tubercles,  varying  in  magnitude,  but  generally  about 
the  size  of  a  mustard  seed.  Sucli  tubercles  become  centres  of  irritation, 
inflammatory  action  and  suppuration,  or  formation  of  abscess,  and  these 
processes  end  by  destroying  a  smaller  or  larger  spot  of  the  hmg-substance, 
and  leave  a  cavity  or  vomica  in  the  pidmonary  structure. 

Causes — The  disease  is  constitutional,  and  according  to  the  reseai'chas 
of  Dr.  Koch,  the  celebrated  Berlin  microscopist,  contagious,  the  whole 
malady  being  the  result  of  development  in  the  lung  of  a  very  minute  bac- 
terium, named  by  Dr.  Koch  the  bacillus  tuberculosis.  Tn  America  it  is 
usually  developed  between  the  time  of  puberty  and  tlie  twenty-iifth  year, 
and  in  nine  cases  out  of  ten  seems  to  be  primarily  lighted  up  by  a  cold 
or  some  depression  of  the  nervous  system. 

Early  Indication — Hemoptysis  or  spitting  of  blood,  usually  in  small 
quantity  and  only  serious  as  a  symptom  of  very  grave  import,  is  often 
one  of  the  earliest  indications  of  pulmonary  consumption. 

Galloping^  Consumption. — Acute  phthisis  or  galloping  consumption  is 
the  most  rapid  form  of  this  terrible  disease,  and  has  been  known  to  prove 
fatal  in  the  short  space  of  six  weeks.  It  usually  commences  with  chills 
and  fever  of  the  hectic  type.     Cough,  dyspnoea  on  very  slight  exertion  and 


544  DISEASES   OF    TlIK    IJKSl'I  UATOK  Y    SVSTKM. 

out  of  all  proportion  to  apparent  amount  of  disease  in  the  lungs,  is 
almost  a  characteristie  of  the  complaint.  The  expectoration  soon  becomes 
profuse,  and  is  freijueutly  tinged  or  streaked  with  hlood.  This  blood  is 
never  mixed  throughout  the  sputum  so  as  to  give  it  the  color  of  rusty  iron, 
which  is  so  indicative  of  pneumonia.  The  pulse  is  frequent  and  feeble, 
the  tongiie  red  and  furred,  the  appetite  poor  or  absent  entirely,  and  there 
is  often  a  tendency  to  diarrhoea. 

2.  In  the  rapid  jjrogress  of  the  disease  there  is,  after  a  few  weeks, 
great  exhaustion,  profuse  sweating,  speedy  emaciation  and  restlessness, 
amounting  in  persons  of  nervous  temperament  to  delirium.  Acute  phthisis 
coming  on  in  this  way  is  almost  without  exception  fatal,  but  in  rare  cases 
there  may  be  a  decrease  in  the  violence  of  the  symptoms,  and  the  patient 
enjoys  a  temporary  improvement,  only,  however,  to  pass  into  the  ordinary 
condition  of  chronic  consumjJtion. 

Treatment. — The  treatment  of  some  of  the  very  few  cases  which  have 
ever  been  reported  as  cured  was  that  of  rest  in  bed,  a  liberal  supply  of 
fluid  nutritious  food  and  stimulants,  frequent  application  of  iced  cloths 
to  the  chest  to  subdue  the  fever,  these  being  at  once  removed  if  there  was 
any  tendency  to  faintness  thereby  produced,  hypodermic  injections  of 
atropia  to  check  tlie  sweating,  and  pills  or  powders  containing  two  grains 
of  quinine,  a  half  grain  of  digitalis,  and  opium  in  amounts  of  from  a 
quarter  to  half  a  grain,  four,  five  or  six  times  daily. 

CHRONIC  PULMONARY  CONSTIMPTION. 

Symptoms — 1.  The  onset  of  chronic  pulmonary  consumption  is  gener- 
ally gradual,  and  marked  by  one  or  more  of  the  symptoms  of  progressive 
debility  and  by  loss  of  flesh,  chronic  dyspepsia,  diarrhoea,  alterations  in 
the  voice,  and  in  females  suppression  of  the  monthly  periods.  In  more 
than  half  the  cases  spitting  of  blood  occurs,  and  a  cold  or  cough  is  ap- 
parently the  starting-point  in  verv  many  instances.  A  dull,  aching  pain 
just  below  the  collar-bones  in  front  or  the  sho^ilder-blades  behind  is  very 
often  complained  of,  even  whilst  the  amount  of  tubercular  deposit  is  small, 
and  is  probably  due  to  little  spots  of  pleuritic  inflammation.  ^Muscular 
pains  in  various  parts  of  the  frame  are  often  present.  The  short,  dry, 
hacking  cough  of  early  phthisis  is  usually  referred  to  some  irritation  about 
the  larynx  or  trachea,  but  is,  in  reality,  due  to  irritation  of  the  bronchial 
mucous  membvnne. 

2.   Weakness  of  tlie  voice   and   hoarseness   are  verv  c(]nini(n),   and   a 


CHEONIC  PDLMONAHY   CONSUMPTION.  645 

purplish  mark  upon  the  edges  of  the  gums,  where  they  come  in  contact 
with  the  teeth,  is  often  observable,  and  is  thought  by  some  physicians  to 
have  considerable  diagnostic  value.  In  at  least  lifty  per  cent,  of  the 
patients  spitting  of  blood  appears  early,  and  recurs  at  various  intervals, 
giving  the  first  positive  evidence  of  the  existence  of  consumption.  Very 
rarely,  however,  is  the  expectoration  of  blood  in  the  early  stage  of  con- 
sumption directly  dangerous  to  life. 

3.  Among  the  other  symptoms  loss  of  strength  is  one  of  the  most 
constant.  The  patient  soon  finds  that  slight  exertion,  such  as  ascending  a 
little  hill,  or  even  a  short  flight  of  stairs,  causes  fatigue,  hurries  the 
breathing  and  often  gives  rise  to  palpitation.  The  uterine  functions  in 
women  are  apt  to  be  disturbed,  and  the  liver  becomes  congested  and 
tender.  The  tongue  gets  red  and  irritable,  and  little  sores  called  apthse 
form  upon  its  sides  and  on  the  mucous  membrane  of  the  fauces. 

4.  Hectic  fever  coming  on  toward  evening  and  giving  a  deceptive 
appearance  of  the  flush  of  health  to  the  emaciated  countenance  develops. 
There  is  a  total  loss  of  appetite  with  great  thirst,  and  the  loss  of  flesh  is 
almost  visible  from  day  to  day.  The  hair  grows  thin  and  loses  it  attach- 
ment to  the  scalp.  The  debility  is  extreme  and  exhaustive  night  sweats 
make  their  appearance.  In  females  there  is  a  total  cessation  of  the 
menses,  which  is  a  most  discouraging  evidence  of  failure  in  vital  power. 
An  unmanageable  diarrhoea  often  sets  in  and  conspires  with  the  other 
causes  of  debility  to  utterly  prostrate  the  unfortunate  invalid.  The  lower 
limbs  become  very  painful,  and  dropsical  swelling  of  the  feet  and  ankles 
appears,  constituting  what  is  vulgarly  called  the  bloating  consumption. 

5.  Toward  the  close,  cough  and  abundant  expectoration  become,  if 
possible,  even  more  troublesome.  Great  nervous  restlessness,  cramps  in 
the  legs,  pain  about  the  loins,  distress  in  passing  water,  utter  prostration 
and  the  ever  present  difficulty  of  getting  the  breath,  tend  to  render  the 
last  few  nights  of  existence  most  agonizing. 

Diagnosis  of  Consumption — It  is  so  important  that  the  diagnosis  of 
consumption  should  be  made  at  the  earliest  possible  period,  when  the 
chance  of  life  by  change  of  climate  is  greatest.  After  the  disease  is  fully 
developed,  and  the  abimdant  expectoration,  great  loss  of  flesh  and  strength, 
night  sweats,  and  associated  sore  throat  from  laryngeal  tuberculosis  mani- 
fest themselves,  there  is  often  no  room  for  doubt  that  consumption  haa 
developed,  even  withoui  the  aid  of  auscultation  and  percussion ;  but  in  the 
incipient  stage  just  grounds  for  suspicion  are  furnished  by  the  presence 
of  slight  hacking  cough  which  has  resisted  the  usual  remedies,  a  little 
35 


546  DISEASES   OF  THE   RESPIRATORY  SYSTEM. 

spitting  of  blood,  provided  the  patient  can  be  sure  that  it  does  not  come 
from  the  gums  or  from  the  back  part  of  the  nose,  and  marked  dyspeptic 
symptoms  with  loss  of  flesh  and  strength  out  of  proportion  to  the  length 
and  apparent  severity  of  the  illness. 

Treatment — 1.  The  treatment  of  consumption  consists  in  the  pallia- 
tion of  symptoms  and  the  administration  of  tablespoonful  doses,  thrice 
daily,  of  cod-liver  oil,  the  phosphates  or  hypophosphites  of  iron,  lime,  and 
the  alkalies ;  the  internal  and  external  use  of  iodine,  and  last  but  not  least, 
of  persistent  counter-irritation  over  the  diseased  spot  in  the  lung,  gen- 
erally near  its  top  and  just  below  the  collar-bone,  with  tartar  emetic  oint- 
ment. Nearly  all  the  cases  of  recovery  from  well-defined  phthisis,  coming 
under  the  observation  of  the  writer,  have  been  apparently  due  in  large 
measure  to  this  system  of  ireatment. 

2.  In  the  second  stage  of  consumption — that  is,  after  the  deposit  of 
tubercular  matter  has  begun  to  soften  and  before  any  large  cavities  have 
formed — the  prospect  of  cure  by  this  or  any  treatment  Is  diminished; 
but  even  from  the  third  stage — that  of  the  formation  of  large  cavities  and 
extensive  destruction  of  lung-tissue — recoveries  occasionally  occur. 

3.  The  palliative  treatment  of  consumption  further  consists  in  re- 
lieving the  cough  and  pain  in  the  chest  by  expectorants  and  anodjmes, 
improving  the  appetite  and  strength  by  tonics  and  stimulants,  controlling 
the  diarrhoea  with  astringents  and  correcting  the  derangements  of  diges- 
tion with  antacids  and  other  anti-dyspeptic  remedies. 

4.  Most  patients  afflicted  with  phthisis  will  find  themselves  for  a  time 
benefited  by,  first,  a  cough  mixture  composed  of  acetate  of  morphia,  cyan- 
ide of  potassium,  syrup  of  squills,  and  syrup  of  wild  cherry  or  syrup  of 
tolu,  as  already  suggested,  used  chiefly  at  night  to  promote  sleep  in  the 
nocturnal  hours  and  allow  the  expectoration  necessary  to  relieve  the  lungs 
from  their  accumulated  load  of  sputum  to  be  carried  on  In  the  daytime; 
or  elix.  of  terpen,  hydrate  and  codeine ;  second,  by  a  pill  of  two  grains  of 
quinine,  half  a  grain  of  digitalis,  and  one-fortieth  of  a  grain  of  strychnia, 
with  the  addition  of  half  a  grain  of  iron,  should  the  condition  of  anemia 
exist  and  there  Is  no  tendency  to  spitting  of  blood  to  forbid  Its  employ- 
ment; third,  by  a  mixture  of  a  teaspoonful  of  syrup  of  krameria,  five 
grains  of  prepared  chalk,  twenty  drops  of  compound  spirit  of  lavender 
and  ten  of  wine  of  opium,  to  check  diarrhoea  when  that  appears ;  and 
■fourth,  by  powders  containing  five  grains  each  of  bismuth,  soda,  charcoal 
and  pepsin,  or  ten  of  lacto-peptlne,  with  wineglassful  doses  of  the  Iiifu- 


HOFF  rEESCRIPTION  FOE  CON  SUMPTION.  547 

sioiis  of  gentian  or  coliirabo,  as  may  be  found  best  adapted  to  tlie  par- 
ticular case  as  stomachics. 

5.  For  patients  mth  whom  morphia  or  opium  disagrees,  codeia,  lactu- 
carium,  chloral,  bromide  of  potassium,  or  hyoscyamus  may  perhaps  be 
substituted,  and  in  some  instances  morphia,  where  illy  borne  alone,  be- 
comes quite  acceptable  to  the  stomach  wheu  associated  with  one  one- 
hundredth  of  a  grain  of  atropia,  or  with  twenty  gTaius  of  bromide  of 
potassium. 

6.  A^^len  obstinate  diarrhcEa  torments  the  invalid,  the  metallic  astrin- 
gents, such  as  half  a  grain  of  sulphate  of  copper,  or  one-quarter  of  a  grain 
of  nitrate  of  silver,  thrice  daily,  are  frequently  useful,  or  ten-grain  doses 
of  subjiit.  bismuth  succeeds  in  controlling  the  intestinal  disorder  whon  all 
other  remedies  prove  unavailing.  The  profuse  aud  debilitating  night 
sweats  may  often  be  checked  by  sponging  with  finely-powdered  alum  and 
whiskey,  by  full  doses  of  quinine,  or  by  hypodermic  injections  of  the 
sulphate  of  atropia. 

7.  Seeing,  however,  that  the  prospect  of  curing  consumption  by 
medical  treatment  is  so  mournfully  gloomy,  it  becomes  doubly  important 
to  urge  that  every  piatient  whose  circimistances  will  admit  should  resort 
to  a  change  of  climate.  And  this  migration  ought  to  be  made  ^vith 
scarcely  a  day's  delay  after  some  amply  competent  authority  has  de- 
termined by  thorough  examination  the  necessity  of  such  a  change  in  the 
colder  seasons  of  the  year. 

THE  HOFF  PRESCRIFIION  FOR  CONSUMPTION. 

Professor  Iloff,  of  Vienna,  claims  most  beneficial  resiilts  from  the 
following  f oiimila : 

Arsenic  Acid 1  part 

Carbonate  of  Potash 2  parts 

Cinnaiuyllic  Acid 3  parts 

Heat  this  until  a  perfect  solution  is  obtained,  then  add  twenty-five 
parts  cognac  and  three  parts  watery  extract  of  opium  which  has  been  dis- 
solved in  twenty-five  parts  of  water  and  filtered. 

Dose:  At  first  take  six  drops  after  dinner  and  supper,  gradually  in- 
creasing to  twenty-two  drojis. 

As  long  as  the  patient  shows  sigiis  of  improvement  the  dose  should 
not  be  increased.     It  is  sometimes  beneficial  to  reduce  it. 

Professor  Hoff  claims  that  the  physiological  action  of  this  remedy  is 


548  DISEASES  OF  THE  KESPIRATORY  SYSTEM. 

peculiar,  in  that  it  docs  not  arrest  seci'etion  in  the  respiratory  or  intestinal 
tract,  while  it  has  marked  power  to  control  inflammation  and  irritation. 
It  stops  all  unnecessary  and  injurious  cwighs,  relieves  the  soreness,  quiets 
the  irritation  and  brings  rest.  He  claims  that  the  results  are  usually 
highly  satisfactory,  that  the  cough  diminishes  more  or  less  rapidly,  dream- 
less sleep  follows,  the  sjratum  becomes  looser  and  the  appetite  increases. 
He  claims  that  it  supersedes  cod-liver  oil  in  more  ways  than  one,  not  the 
least  of  which  is  that  it  is  palatable,  consequently  it  does  not  disorder  di- 
gestion or  produce  nausea.  By  its  use  the  cough  is  at  once  ameliorated, 
the  perspiration  is  diminished,  the  patient  is  strengthened,  thereby  en- 
abling him  to  expectorate  the  loosened  miicus  with  gi'eater  ease,  and  fre- 
quently the  consumptive  steadily  improves  and  regains  health. 

Professor  Hoif  claims  that  mild  cases  have  been  quickly  cured  and 
partial  cures  have  been  eilected  in  severe  cases,  the  appetite  and  weight 
increasing  steadily  and  there  being  a  steady  lessening  of  fever,  night 
sweats,  insomnia  and  asthmatic  symptoms.  He  points  out  that  in  using 
the  treatment  the  patient  must  keep  the  kidneys  in  order.  The  duration 
of  treatment  depends  upon  the  condition  of  the  patient.  Professor 
Hoff  declares  that  mild  cases  are  sometimes  cured  in  a  few  months  while 
those  more  severe  may  require  a  year  or  two.  It  is  essential  that  the  solu- 
tion be  taken  after  eating,  when  the  stomach  is  full. 

PLEURISY. 

This  disease  is  an  inflammation  of  the  pleura,  or  delicate  membrane 
which  surrounds  each  lung. 

Causes — Pleurisy  presents  itself  under  two  forms — the  acute  and  the 
chronic.  Its  common  cause  is  exposure  to  cold,  but  sometimes  it  arises 
from  injury,  as,  for  example,  from  the  pleura  being  wounded  by  the 
jagged  end  of  a  broken  rib;  or,  secondarily,  adjacent  inflammation,  such 
as  takes  place  around  a  nodule  or  tubercular  deposit  in  consumption,  or 
in  the  course  of  some  other  disease,  for  instance,  Bright's  disease  or 
scarlet  fever. 

Symptoms 1.  The  onset  of  acute  pleiirisy  may  be  insidious,  but  gen- 
erally, Avhen  arising  from  its  usual  cause,  exposure  to  a  very  severe  cold,  it 
is  rather  sudden  and  marked  by  repeated  chills.  As  soon  as  the  patient 
reacts  from  these,  the  temperature  begins  to  rise  and  thus  furnishes  a 
distinguishing  symptom  which  often  enables  the  complaint  to  be  dis- 
criminated from  pneumonia. 


PLEURISY.  549 

2.  At  the  same  time,  or  very  soon  after  the  rise  in  temperature,  pain, 
cough  and  dyspnoea  are  observed.  The  pain  is  ahnost  always  referred  to 
the  affected  side,  a  few  inches  below  the  nipple,  and  is  sharp  and  darting, 
described  as  resembling  a  stab  with  a  keen  knife,  esi^ecially  on  trying  to 
take  a  deep  inspiration  or  to  cough.  As  a  rule,  the  diificulty  of  breathing 
is  slight  and  mainly  due  to  the  pain  in  the  side  and  to  the  febrile  excite- 
ment in  the  system.  The  cough  is  short,  hacking,  and  accompanied  with 
little  or  no  expectoration;  the  pulse  is  quickened;  the  tongue  is  some- 
what furred,  the  appetite  impaired,  but  the  thirst  is  increased,  and  the 
bowels  are  confined. 

3.  After  a  variable  period,  averaging,  perhaps,  between  one  and  two 
weeks,  the  attack  usually  terminates  in  recovery,  with  or  withoiit  a  con- 
traction of  the  wall  of  the  chest  on  the  affected  side,  according  as  the 
lung  is  able  to  expand  after  being  compressed  by  the  effused  fluid ;  or  the 
malady  may  end  in  the  chronic  form  of  pleurisy,  or  very  rarely  in  the 
uncomplicated  affection  it  may  have  a  fatal  result. 

4.  In  chronic  pleurisy  the  effused  liquid  remains  in  the  pleural  sac, 
without  becoming  absorbed.  It  is  especially  apt  to  become  purulent  in  a 
short  period  in  children,  or  in  persons  whose  health  is  impaired  from  any 
cause.  When  this  degeneration  takes  place  there  is  always  more  or  less 
febrile  disturbance  of  a  hectic  type  set  np  in  the  system  generally.  The 
skin  of  the  affected  side  after  a  while  becomes,  over  the  seat  of  the 
effusion,  reddened,  tender,  swollen  and  dropsical.  The  finger  nails  are 
often  clubbed,  as  in  consumption,  and  night-sweats  are  not  infrequent. 
Cough  is  apt  to  be  troublesome  and  may  be  accompanied  by  an  expectora- 
tion of  muco-pus,  which  in  rare  cases  possesses  a  putrid  odor. 

Diagnosis. — The  diagnosis  of  pleurisy  without  the  aid  of  auscultation 
and  percussion,  must  often  be  difficult,  at  least  for  the  first  few  days  of 
the  attack,  but  it  can  sometimes  be  made  from  pneumonia  by  the  lower 
grade  of  fever,  the  small  amount  of  dyspnoea,  and  the  total  absence  of 
rusty  expectoration.  It  can  he  distinguished  from  bronchitis  by  the 
small  amount  of  cough,  and  the  sharpness  of  its  pain,  and  from  acute 
phthisis  by  the  strength  being  but  slightly  diminished. 

Treatment — 1.  The  treatment  of  pleurisy  in  the  first  stage,  when 
acute  pain  is  the  most  prominent  symptom,  is  bleeding,  leeching  or  cup- 
ping over  the  affected  side,  if  the  patient  is  robust  and  previously  in  good 
health.  In  persons  of  feeble  constitution  it  is  better  to  apply  ten  or 
twelve  dry  cups,  and  then  use  hot  j^oultices  with  laudanum  for  the  further 
relief  of  pain,  than  to  deplete  the  system,  or  turpentine  and  sweet  oil.     If 


550  DISEASES  OF  THE  RERPIRATOT5Y   SYSTEM. 

suited  to  the  patieut,  hypodermic  injections  of  morphia  are  of  great  ser- 
vice. After  the  second  day  free  watery  purgation  by  a  tablespoonful  o£ 
rochelle  salts,  epsom  salts,  or  a  bottle  of  citrate  of  magnesia,  and  a  restric- 
tion of  the  amount  of  fluid  taken  into  the  stomach,  are  advisable,  in  order 
to  limit  the  tendency  of  effusion  into  the  pleural  sac  as  far  as  possible. 
If  the  febrile  movement  runs  very  high,  veratrum  viride  or  aconite,  in 
three  to  five-drops  doses  of  its  tincture,  may  be  given  to  reduce  the  pulse 
and  heart's  action,  but  this  is  rarely  necessary. 

2.  In  the  second  stage  after  effusion  has  occurred,  the  chief  indica- 
tion is  to  reduce  the  amoimt  of  this  serous  liquid  as  speedily  as  possible, 
and  for  such  a  purpose  diuretics  and  saline  purgatives  or  elaterium,  in 
quantities  of  half  a  grain  every  three  hours,  or  so  as  to  cause  abundant 
watery  discharges,  may  be  given ;  counter-irritation  by  iodine  and  small 
blisters  being  kept  Tip  over  the  diseased  side  of  the  thorax.  If  the  liquid 
is  effused  in  large  amount  and  causes  much  interference  with  respiration, 
it  may  be  necessary  to  draw  it  off  by  means  of  an  aspirating  apparatus. 

Diet — As  the  cure  progresses  tonics,  good  nourishing  food  and  early 
exerc"se  in  the  open  air  in  suitable  weather,  are  highly  important. 

Hydrothoras — This  is  the  name  applied  to  that  diseased  condition 
where  there  is  an  accumulation  of  water  or  serous  fluid  in  the  cavity  of 
the  chest.  It  may  be  the  result  of  pleuritic  inflammation,  but  not  un- 
frequently  occurs  in  dropsy  without  inflammatory  action.  Sometimes  it 
increases  to  an  enormous  amount,  pressing  on  the  lungs  and  displacing 
the  heart,  with  such  great  interference  to  the  respiration  and  circulation 
as  to  prove  the  immediate  cause  of  death,  unless  removed  by  aspiration,  or 
exhaling  the  breath  through  an  opening  in  the  pleura. 

Pneumothorax — This  is  the  term  applied  to  the  morbid  state  in  which 
air  has  entered  and  partly  occupies  the  cavity  of  the  pleura,  compressing 
the  lung  in  the  same  way  though  less  forcibly  than  does  a  watery  effusion. 
This  accident  sometimes  occurs  from  the  rupture  of  the  vesicles  of  the 
lung  through  the  pleural  membrane  into  the  cavity  of  the  pleural  sac. 
At  other  times  it  results  from  some  injury  to  the  chest,  such  as  a  gun-shot 
wound  or  the  fracture  of  a  rib.  Where  closure  of  the  aperature  by  which 
this  air  found  an  entrance  can  be  secured,  it  may  be  necessary,  in  order 
to  relieve  the  oppression  of  breathing,  to  pump  out  the  air  by  means  of 
the  aspirating  apparatus. 

Emphysema — This  is  the  accumulation  of  air  under  the  skin  in  the 
Bubcutaneous  connective  tissue  j  it  is  a  curious  result  occasionally  met  with 


CAISSON   OR    COMPKESSED    AIE   DISEASE.  551 

from  wounds  of  the  pleura,  such  as  those  produced  by  compound  fractures 
of  the  ribs  aud  other  causes.  This  distension  of  the  integument  with  air 
may  progress  until  all  semblance  of  humanity  is  lost  aud  yet  entire 
recovery  takes  place.  It  may  almost  always  be  prevented  by  proper  at- 
tention to  the  primary  injury. 

Other  Diseases  of  the  Pleura — The  membrane  of  the  pleura  may  be 
affected  with  cancer,  simple  tumors,  tubercle  and  parasitic  growths,  but 
these  are  very  uncommon,  except  as  secondary  manifestations  of  extensive 
disease  of  the  same  kind  in  other  portions  of  the  body,  in  which  cases  the 
latter  are  consequently  the  proper  subjects  of  whatever  treatment  becomes 
needful. 

CAISSON  OR  COMPRESSED  AIR  DISEASE. 

This  is  a  disease  occurring  among  laborers,  engineers  or  any  person 
compelled  to  work  for  any  lengtii  of  time  in  timnels,  jetties,  foundations 
for  bridges,  etc.,  where  it  is  necessary  for  a  caisson  to  be  used  containing 
compressed  air.  It  is,  therefore,  not  a  germ  disease,  but  causes  sickness 
among  laborers  by  the  constant  breathing  ijito  their  lungs  this  compressed 
air. 

The  latest  theories  in  regard  to  how  this  compressed  air  aft'ects  the 
system  of  healthy  persons  are  that  the  tissues  and  fluids  of  the  body  be- 
come saturated  with  the  gasses  of  the  atmosphere  to  a  degree  which  depends 
upon  ( 1 )  the  amount  of  pressure  of  the  compressed  air  in  the  caisson ; 
(2)  the  length  of  time  they  are  exposed  to  it;  (3)  the  activity  of  the  cir- 
culation and  the  ability  of  the  individual's  tissues  as  regards  the  rapidity 
with  which  the  gases  are  absorbed. 

No  matter  how  high  the  compressing  of  the  air  in  the  caisson  is, 
symptoms  do  not  occur  until  the  man  leaves  the  caisson  and  breathes  the 
atmospheric  air. 

The  disease  is  principally  due  to  the  formation  of  air  bubbles  (chiefly 
nitrogen)  within  the  body  brought  about  by  decompression  (meaning  that 
the  atmospheric  air  removes  the  pressure  from  the  lungs  when  the  person 
is  relieved  from  the  compressed  air  in  the  caisson.  This  relief  takes 
place  so  rapidly  that  the  gases  fonned  in  the  blood  cannot  be  carried  to 
the  lungs  and  thrown  off  as  gradually  as  they  entered;  as  a  result,  gases 
in  the  fonn  of  air  bubbles,  form  in  the  blood  and  tissues  and  damage  them 
by  the  force  of  their  expansion. 

When  a  man  is  in  a  caisson  working  under  compressed  air,  the  tirst 


563  DISEASES  OF  TITE  RESPIEATOKT  SYSTEM. 

effects  lie  notices  are  more  of  a  functional  nature  than  the  symptoms  of 
caisson  disease,  they  are  practically  mechanical  due  to  the  pressure  of  the 
contained  air.  He  feels  that  the  car-drum  membranes  are  forced  inward, 
-svhicli  cause  discomfort,  perhaps  pain.  The^'  may  rujiture.  Rise  of  tem- 
perature with  sweating  due  to  the  heat  caused  by  the  compressed  air.  It 
is  diificult  to  force  the  air  out  of  the  lungs.  Whistling  or  whispering  can- 
not be  done,  and  the  attempt  causes  a  sensation  of  numbness  In  the  lips, 
which  also  do  not  move.  The  voice  Is  changed  and  Is  done  through  the 
nose.  A  sensation  of  well  being  and  excitement  Is  felt  by  the  laborer. 
The  skin  does  not  change  Its  color  nor  Is  the  normal  rate  of  the  pulse 
altered. 

The  Symptoms  of  Caisson  Disease. — These  never  occur  while  the  man 
is  In  the  caisson,  but  usually  come  on  In  fifteen  minutes  to  twenty-four 
hours  after  he  has  left  the  caisson  and  breathes  normal  atmospheric  air. 
Pains  in  the  knees  and  elbows  are  the  most  frequent  symptoms ;  they  also 
occur  at  times  In  abdomen.  The  pains  in  the  knees  cause  the  person  to 
bend  his  knees  and  the  attitude  has  been  termed  "the  bends."  Dizziness 
occurs  and  is  spoken  of  by  the  laborers  as  the  "staggers."  Nausea  and 
vomiting  may  come  on.  Difficult  breathing  develops  in  some  men  and  Is 
spoken  of  as  "chokes."  Prostration  and  collapse  occur  rarely  and  the 
patient  becomes  unconscious.  These  symptoms  have  been  followed  by 
death.  Itching  of  the  skin  occurs,  supposed  to  be  due  to  the  presence  of 
air  bubbles  In  the  sweat  glands  In  the  skin. 

Workers  in  compressed  air  who  have  followed  such  labor  for  years 
are  usually  apt  to  suffer  from  deafness,  "bends"  or  severe  pains  In  the 
knees.  Temporary  or  permanent  paralysis  of  the  legs  and  arms  are  a  rare 
complication. 

Treatment  for  this  Disease. — There  is,  of  course,  no  home  treatment 
Most  of  the  large  contractors  who  builds  tunnels,  bridges,  etc.,  have  their 
own  physicians  at  hand  to  treat  all  laborers  overcome  upon  removal  from 
the  caisson.  Special  treatment  is  necessary  under  the  care  of  speciallsta 
in  this  disease. 

There  is  no  method  of  preventing  this  disease  as  long  as  men  must 
work  under  compressed  air.  It  attacks  the  healthiest  of  men  who  are 
free  from  disease  and  well  nourished  at  the  time  of  going  to  work. 


PART  VII  OF  BOOK  IV 

Treats  of  the  Digestive  System  and  the  diseases 
affecting  the  different  parts,  giving  the  best  and 
newest  treatments. 


Abdominal  Dropsy   593 

Atrophy  of  the  Liver 592 

Abscess  of  the  Gum   559 

Abscess  of  the  Liver  591 

Treatment  of 592 

Abscess  of  Tonsil  565 

Acute   Gastritis    567 

Acute  Stomatitis   556 

/Esophagus,  Diseases  of  566 

Anus,  Fissure  of  589 

Aphthous  Stomatitis 556 

Treatment  of   556 

Appendicitis    575 

Treatment  of   577 

Appendix,  Inflammation  of   575 

Function   of    575 

Ascites    593 

Treatment  of   593 

Baby's  Sore  Mouth   SSS 

Bowels,  Inflammation  of   574 

Cancer  of  the  Lip  555 

Cancer  of  the  Tongue  560 

Treatment  of   560 

Cancer  of  the  Stomach 571 

Treatment  of   571 

Cancrum   Oris    557 

Cirrhosis  of  the  Liver   592 

Clergymen's -Sore  Throat 561 

Colic 587 

Hepatic    592 

Liver    592 

Colitis   574 

Treatment  of   574 

Congestion  of  Liver    591 

Constipation    583 

Treatment  of   583 

Costiveness    583 

Dentition,   Difficult    550 

Diarrhcea    581 

5 


DifiRcult    Dentition    559 

Diseases  of  the  Lip   555 

Dropsy,   Abdominal    593 

Dysentery    579 

Treatment  of    580 

Dyspepsia    568 

Treatment  of   569 

Enteritis    574 

Treatment  of   574 

Epulis    559 

Falling  of  the  Anus   589 

Fissure  of  the  Lip   555 

Fistula  in  Ano  589 

Follicular   Stomatitis    556 

Gall-Stones     590,  592 

Treatment  of 590,  593 

Gangrenous   Stomatitis    557 

Gastritis,  Acute   567 

Treatment  of   567 

Gullet,   Stricture  of   566 

Gum,  Abscess  of  559 

Gum   Boil    559 

Treatment  of   559 

Gum,  Inflammation  of  558 

Gum   Tumors   559 

Hare-lip    ....555 

Hemorrhoids    588 

Hepatic  Colic   592 

Hernia    584 

Inflammation  of  the  Appendix  575 

Bowrels    574 

Gum    558 

Mouth   555 

Stomach    567 

Tonsils    561 

Intestinal  Obstruction   578 

Treatment  of  579 

Worms    586 

Jaundice    590 


554 


INDEX   TO   PART   Vl   OF   BOOK  IV. 


Lip,  Cancer  of  S5S 

Diseases  of  555 

Fissure  of   555 

Ulceration  of   555 

Liver,  Abscess  of   591 

Atrophy  of   592 

Colic    592 

Liver  Complaint   594 

Treatment  of   595 

Liver,  Congestion  of   591 

Treatment  of   591 

Liver,   Cirrhosis    592 

Diseases  of   590 

Waxy 592 

Mercurial    Stomatitis    558 

Mouth,  Inflammation  of 555 

Noma 557 

Palate,  Perforation  of 559 

Parasitic   Stomatitis   557 

Perforation  of  Palate   559 

Treatment  of   560 

Peritonitis    573 

Treatment  of   573 

Piles    588 

Treatment  of 588 

Pin-Worms   587 

Prolapsus  Ani   589 

Putrid  Sore  Mouth   557 

Quinsy 565 

Treatment  of   565 

Round- Worm   586 

Rupture    584 

Treatment  of   585 

Salivation    558 

Simple  Stomatitis   556 

Treatment  of    556 

Sore  Mouth,  Baby's   555 

Putrid    557 

Sore  Throat   561 

Clergymen's  561 


Stomach,  Cancer  of  571 

Inflammation  of  567 

Ulcer  of  571 

Stomatitis 555 

Acute    556 

Aphthous    556 

Causes  of 555 

Follicular  556 

Gangrenous   557 

Mercurial   558 

Parasitic  557 

Simple 556 

Symptoms  of   556 

Ulcerative  557 

Stricture  of  the  Gullet 566 

Tape- Worms 587 

Teething   559 

Throat,  Sore  561 

Thrush    557 

Tongue,  The 562 

Cancer  of    560 

Ulceration  of 560 

Tongue-Tie   560 

Treatment  of  560 

Tonsillitis 561 

Treatment  of 564 

Tonsils,  Inflammation  of   561 

Abscess  of 565 

Tumors  of  the  Gum   559 

Ulcer  of  the  Stomach  571 

Symptoms  of   572 

Treatment  of  573 

Ulceration  of  the  Lip  55S 

Ulceration  of  the  Tongue   560 

Treatment  of 560 

Ulcerative  Stomatitis  557 

Treatment  of   557 

Waxy  Liver   592 

Worms,  Intestinal 586 


ILLUSTRATIONS 


The  Kidney  590 

The  Liver 59a 


The  Tongue   563 


CURATIVE    MEDICINE 


TART  VII. 
DISEASES  OF  THE  DIGESTIVE  SYSTEM 

In  considering  the  maladies  of  the  digestive  system  frequent  refer- 
ences must  be  made  to  the  anatomy  of  the  alimentary  tract,  and  to  the 
physiology  of  digestion. 

LIP  DISEASES. 

Among  the  common  diseases  of  the  lips  are  nlceration  and  fissure, 
which  may  often  be  induced  to  heal  by  light  apijlications  of  nitrate  of 
silver  solution,  in  conjunction  with  diligent  improvement  of  the  general 
health.  Cancer  of  the  lip  is  not  uncommon  among  men  in  advanced  life, 
but  is  less  frequent  in  females.  It  should  be  operated  on  in  accordance 
with  the  rules  already  laid  down,  in  discussing  the  subject  of  cancer. 
Hare-lip  is  a  curious  malformation,  in  which  the  upper  lip  has  failed  to 
develop  in  such  a  way  as  to  unite  in  the  centre  previous  to  birth,  and  the 
child  is  left  with  a  deep  cleft,  sometimes  reaching  all  the  way  from  the 
edge  of  the  nostril.  This  malformation  can  generally  be  remedied  by  a 
surgical  operation. 

STOMATITIS  OR  INFLAMMATION  OF  THE  MOUTH. 

This  is  commonly  met  with  in  young  infants,  and  is  called  "baby's 
fore  mouth."  It  consists  of  an  inflammation  of  the  mucous  membrane 
of  the  moiith  and  tongue. 

Causes. — These  may  be : 

1.  Mechanical,  chemical,  thermal  or  parasitic. 

2.  Poisons,  as  mercury  or  lead. 

3.  In  certain  debilitating  diseases,  as  consumption  or  diabetes. 

4.  It  is  most  commonly  found  in  young  children,  in  connection  with 

(555) 


S56  DISEASES   OF   THE   HIGESTIVE    SYSTEM. 

digestive  disturbances,   due  to  artificial  feeding  and    bad  hygienic  sur- 
roundings, especially  during  the  summer  months. 

General  Symptoms — There  are  six  chief  subdivisions  of  stomatitis,  and 
seven  general  symptoms  common  to  all  varieties.  These  are  heat,  pain 
and  redness  of  the  mouth,  increased  salivation,  foul  breath,  restlessness 
and  disinclination  to  nurse. 

VARIETIES  OF  INFLAMMATION  OF  THE  MOUTH  (STOMATITIS) 

I.    ACUTE  OR  SIMPLE  STOMATITIS. 

This  is  the  most  common  form  in  inflammation  of  the  mouth,  and  is 
usually  the  result  of  the  action  of  irritants.  It  is  freqiient  at  all  ages  and 
is  especially  common  in  imhealthy  subjects  suffering  from,  digestive  dis- 
turbances. 

Symptoms — General  redness.  There  may  be  areas  of  marked  con- 
gestion wlicre  irritation  is  most  intense.     Mastication  is  painful. 

Treatment — In  infants  the  month  should  be  carefully  sponged  after 
each  feeding.  Chlorate  of  potash  and  sulphite  of  soda  as  mouth-washes 
and  gargles,  of  the  strength  of  a  dram  to  four  ounces  of  water,  are  useful, 
or,  in  severe  cases,  a  dilute  solution  of  nitrate  of  silver  (three  or  four 
grains  to  oimce)  may  be  applied,  and  attention  ought  to  be  paid  to  im- 
proving the  general  health  by  the  use  of  tonics,  nutritious  food,  and  so 
forth. 

II.    APHTHOUS  STOMATITIS  OR  FOLLICULAR  STOMATITIS. 

This  is  characterized  by  the  presence  of  small  raised  spots  or  vesicles, 
■which  may  rupture,  leaving  small  ulcers,  surrounded  with  a  red  bole. 
This  form  of  stomatitis  occurs  most  frequently  in  children  under  three 
years  of  age.     There  are  usually  some  digestive  disturbances  present. 

Treatment. — Correct  digestive  disturbances ;  sterilize  the  milk ;  nurse 
at  regular  intervals,  and  cleanse  the  mouth  with  a  linen  rag  after  each 
nursing.    Ajiply  to  mouth  and  gums  three  or  four  times  a  day : 


Boric   acid    15  grains 

Glycerine     '-  ounce 

Water  up  to    2  ounces 

If  the  disease  does  not  yield  to  this  treatment,  touch  the  ulcers  with 
solid  nitrate  of  silver  stick. 


GANGKENULS    STOMATITIS.  667 


III.    PUTRID  SORE  MOUTH  OR  ULCERATIVE  STOMATITIS. 

This  variety  occurs  especially  in  children  after  the  first  dentition. 
It  is  thought  by  some  to  be  infections,  as  it  at  times  occurs  in  widespread 
epidemics.     It  attacks  both  adults  and  children. 

Symptoms. — It  occiirs  with  low  condition  of  nutrition.  The  gums  of 
the  lower  jaw  are  chiefly  affected.  They  are  swollen,  red  and  spongy. 
There  is  increased  salivation,  the  teeth  become  loose,  the  breath  foul  and 
mastication  painful.     In  rare  cases  there  is  necrosis  (decay)  of  lower  jaw. 

Treatment. — Correct  the  hygiene.  Touch  ulcers  with  nitrate  of  silver, 
and  use  as  a  moiith-wash  a  solution  of  chlorate  of  potash,  fifteen  grains 
to  the  ounce.  The  best  remedy  is  chlorate  of  potash,  given  internally,  in 
doses  of  two  grains,  three  times  a  day,  to  a  child,  and  double  that  amount 
to  an  adult. 

IV.    PARASITIC  STOMATITIS  OR  THRUSH. 

This  disease  is  dependent  upon  the  growth  of  an  irritating  fungus 
(Saccharomysis  albicaiis).  The  development  of  thrush  over  the  whole 
lining  membrane  of  mouth  and  throat  is  very  common  shortly  before 
death  in  wasting  diseases,  such  as  consumption  and  diabetes.  It  may 
occur  at  any  age,  but  is  especially  common  in  children. 

Symptoms — It  begins  on  the  tongue  as  slightly  ra.sed  pearly  spots, 
which  spread  and  coalesce.  The  membrane  can  be  scraped  off,  and  is 
readily  recognized  under  the  microscope.  It  may  spread  to  the  pharynx, 
oesophagus  or  larynx. 

Treatment Correct  the  hygiene;  treat  as  any  gastric  disturbances. 

Tonics  are  often  indicated.  Locally,  use  sulphite  of  sodium,  one  dram 
to  the  ouuce  of  water,  or 

Borax     I  drachm 

Glycerine    2  drachms 

Water     6  drachms 

Apply  two  or  three  times  a  day  to  gums  and  mouth. 

V.    GANGRENOUS  STOMATITIS,  OR  CANCRUM  ORIS  OR  NOMA. 

This  terrible,  but  fortunately  rare,  disease  is  usually  seen  in  debili- 
tated children,  between  the  ages  of  two  and  six  years.  It  usually  follows 
one  of  the  specific  fevers,  especially  measles  and  whooping-cough. 

Symptoms. — The  general  symptoms  of  stomatitis  are  marked.     Th ; 


658  DISEASES   OF   THE  DIGESTIVE  SYSTEM. 

mucous  membrane  is  first  affected,  usually  of  the  gums  or  of  one  cheek. 
The  process  begins  gradually.  Externally  the  cheek  is  swollen  hard,  red 
and  glazed,  and  inside  the  mouth  is  seen  an  ulcer  with  a  great  deal  of 
proud  flesh  or  slough. 

Treatment — Good  hygiene ;  alcoholic  stimulants ;  nutritious  food  and 
tonics,  as  iron,  quinine  and  strychnia.  Locally,  there  is  nothing  that  will 
do  much  good,  but  the  actual  caiitery  applied  to  tlie  surface  is  said  to  be 
of  some  use,  as  is  the  application  of  fuming  nitric  acid,  followed  by  soda, 
the  surrounding  parts  being  protected  with  lint  soaked  with  oih 

VI.    MERCURIAL  STOMATITIS  OR  SALIVATION. 

This  form  is  very  seldom  seen  at  present,  except  in  those  who  work 
in  mercury. 

Causes — It  may  be  caused  by  the  administration  of  mercury  in  any 
form.  It  is  most  commonly  produced  by  large  doses,  or  even  small  doses, 
of  calomel  in  those  who  are  especially  susceptible. 

Symptoms. — Those  first  noticed  are  tenderness  of  the  gums,  mani- 
fested by  forcibly  bringing  the  teeth  together,  redness  of  gums  near  the 
insertion  of  the  teeth,  a  metallic  taste  and  an  increased  flow  of  saliva.  If 
the  disease  is  not  checked  at  this  stage  these  symptoms  will  become  ac- 
centuated, and  there  will  be  profuse  flow  of  saliva,  foul  breath,  redness, 
swollen  and  tender  gums.  In  severe  cases  there  may  be  ulceration  of  the 
gums. 

Treatment. — The  administration  of  mercury  should  be  suspended  as 
soon  as  there  is  the  first  symptom  of  salivation.  Bowels  should  be  opened 
by  magnesium  sulphate  (half  an  ounce) ;  best  taken  in  half  a  glass  of 
water  before  breakfast.  Hot  baths  should  be  taken  every  evening,  and 
alkaline  waters  should  be  taken  in  large  quantities.  Atropine  sulphate, 
one  one-hundredth  of  a  grain  may  be  taken  twice  a  day,  and  iodide  of 
potassium,  five  grains,  thi'ee  times  a  day. 

DISEASES  OF  THE  GUMS 

These  generally  require  the  care  of  a  dentist,  and  when  connected 
with  affections  of  the  teeth,  or  their  sockets  in  the  alveolar  processes,  are 
usually  so  painful  that  prompt  application  to  a  dental  practitioner  is 
made. 

Inflammation  of  the  Gum. — This,  when  conjoined  with  ulceration  at 


DIFFICPLT  DENTITIOS,  559 

the  root  of  a  tooth,  gives  rise  to  horrible  suffering  which  lasta  for  three  or 
four  days,  when  it  is  usually  relieved  by  the  discharge  of  matter  or  pus. 
This  may  be  hastened  by  hot  applications. 

Treatment. — The  pain  can  be  somewhat  mitigated  by  anodynes,  such 
as  ten  grains  of  Dover's  powder  or  one-sixth  of  a  grain  of  morphia,  and 
poultices,  but  the  best  treatment  is  the  extraction  of  the  offending  tooth, 
or  the  perforation  of  the  alveolar  process  to  the  seat  of  trouble  by  drilling 
a  hole  through  the  spongy  bone. 

ABSCESS  OF  THE  GTJM  OR  GUM  BOIL. 

This  is  sometimes  followed  by  ulceration,  which  may  be  hard  to  heal 
unless  the  whole  cause  of  the  difficulty  is  removed,  which  can  now  be 
accomplished  imder  nitrous  oxide  gas  so  quickly,  painlessly  and  safely, 
that  no  time  should  be  lost  in  resorting  to  it.  One  extremely  skillful 
operator  in  Philadelphia  has  now  administered  the  gas  for  operations  on 
the  teeth  in  over  one  hundred  thousand  cases  without  a  single  fatal  result. 

Hypertrophy  and  atrophy  of  the  gums  are  sometimes  met  with. 

DIFFICULT  DENTITION. 

Treatment — A  very  common  cause  of  diseases  of  the  stomach  and 
bowels,  and  also  of  convulsions  in  children,  is  to  be  found  in  the  harden- 
ing or  induration  of  the  gums  at  the  time  of  teething,  and  this  blunder  of 
nature's  ought  to  be  promptly  remedied  whenever  the  gums  in  infants 
at  the  time  of  the  first  dentition  are  found  to  be  red,  swollen,  and  hot  to 
the  touch,  by  the  use  of  the  lancet.  This  little  operation  of  lancing  the 
gums,  which,  simple  as  it  is,  has  probably  saved  the  lives  of  thousands  of 
young  children.  After  the  incisions  are  made  bleeding  should  be  en- 
couraged, but  care  must  be  taken  by  wiping  it  off  with  a  handkerchief  to 
prevent  the  infant  from  swallowing  the  blood.  It  is  astonishing  what 
relief  is  often  afforded  to  the  little  sufferer  by  a  timely  lancing  of  the 
gums. 

Gum  Tumors. — Tumors  of  various  kinds  sometimes  make  their  ap- 
pearance upon  the  gums,  the  most  common  of  those  which  are  non-malig- 
nant being  the  fibrous  growths  called  epulis,  often  apparently  caused  by 
the  irritation  of  diseased  and  neglected  teeth.  They  all  usually  require 
surgical  operations  for  their  removal. 

Perforation  of  Palate — Perforation  of  the  hard  palate  or  roof  of  the 
mouth  is  sometimes  a  malformation  present  from  birth,  and  due  to  the 


5G0  DISEASES   OF   THE  DIGESTIVE  SYSTEM. 

same  kind  of  arrest  of  development  as  bare-lip.  At  other  times  it  may  be 
due  to  venereal  or  scrofulous  disease.  A  surgeon  can  do  much  to  cure 
this  deformity  by  operation,  or  to  remedy  the  defect  if  incurable  by 
surgical  appliances,  which  substitute  most  ingeniously  the  deficient  por- 
tions of  the  mouth. 


DISEASES  OF  THE  TONGUE 

The  Tongue  is  subject  to  almost  all  the  diseases  already  spoken  of  as 
affecting  the  inside  of  the  mouth,  for  which  similar  treatment  is  required. 
Troublesome  little  ulcers  on  the  tongue  can  often  be  promptly  cured  by 
holding  in  contact  with  the  sore  a  pinch  of  powdered  borax  for  ten  or  fif- 
teen minutes.  Deeper  ulcers  may  require  touching  with  the  solid  nitrate 
of  silver,  and  if  dependent  upon  the  constitutional  taint  of  syphilis  will 
be  very  difficult  to  heal  without  the  use  of  internal  remedies  also. 

CANCER  OF  THE  TONGUE. 

Cancer  of  the  Tongue  appears  sometimes  to  have  its  origin  late  in  life 
from  the  local  irritation  of  the  stem  of  a  pipe  in  habitual  smokers,  or  from 
the  sharp  corner  of  a  broken  or  isolated  tooth.  Hence  it  is  important  to 
avoid  these  exciting  causes  as  much  as  possible.  The  operation  for  re- 
moval of  cancer  when  seated  in  the  tongue  is  more  justifiable  than  almost 
any  other,  because,  if  recurrence  should  take  place  in  the  glands  of  the 
neck,  or  still  better,  in  some  internal  organ,  death  comes  to  the  victim  in 
a  much  less  painful  and  horrible  form. 

TONGITE-TIE. 

Tongue-tie  is  a  malformation  in  which,  from  the  prolongation  of  the 
little  membranous  band,  called  the  frsenum,  underneath  the  tongue,  the 
organ,  even  to  its  very  tip,  is  in  some  cases  tied  down  to  the  lower  jaw. 
If,  as  occasionally  happens,  it  interferes  with  a  baby's  nursing,  it  should 
be  operated  upon  the  next  day  after  birth  by  nicking  the  band  at  the 
front  edge,  and  then  tearing  it  back  to  about  the  usual  position.  No  cut- 
ting operation  should  be  resorted  to,  except  in  this  very  superficial  way, 
on  account  of  a  very  active  little  artery  which  lies  at  the  root  of  the 
tongue,  and  which,  if  wounded,  might  bleed  so  as  to  endanger  an  infant's 
life  before  the  hemorrhage  could  be  checked.     On  this  account,  if  nursing 


DISEASES   OF  THE   TIIEOAT.  561 

is  not  seriously  interfered  with,  it  is  better  to  wait  some  months  before 
thus  untying  the  tongue. 


DISEASES  OF  THE  THROAT 

Sore  throat,  which  may  bo  considered  as  comprising  inflammation  of 
the  mucous  membrane  lining  both  the  fauces  and  the  pharynx,  as  they 
nearly  always  occur  together,  is  one  of  the  commonest  disorders.  It  is 
occasionally  produced  by  attempting  to  SAvallow  some  irritating  article  of 
food,  or  poison,  but  is  ordinarily  the  result  of  cold.  It  also  occurs  in  the 
course  of  various  febrile  affections,  such  as  scarlet  fever. 

Symptoms. — The  symjjtoms  are  jiain  on  swallowing,  redness  of  the 
surface,  and  at  first  dryness,  but  after  a  day  or  two  later  excessive 
secretion  from  the  mucous  membrane.  Subsequently  to  partial  recovery 
from  an  acute  sore  throat,  the  condition  may  be  one  of  relaxation,  the 
membrane  remaining  loose  and  flabby,  and  often  thrown  into  projecting 
folds.  This  state  usually  follows  cold  and  sore  throat,  but  may  be  induced 
by  mechanical  causes,  such  as  severe,  hoarse  cough,  screaming,  shouting, 
or  over-straining  in  reading  or  singing.  It  may  also  be  brought  on  by 
excessive  smoking. 

Clergymen's  Sore  Throat. — One  form  of  this  malady,  called  clergy- 
men's sore  throat,  is  the  result  of  excessive  iise  of  the  voice  in  church 
service  when  the  health  is  already  impaired,  especially  when  the  air  of 
the  apartment  in  which  such  exertion  is  made  has  been  rendered  impure 
by  overcrowding.  In  bad  cases  of  sore  throat,  the  inflammation  may  go 
on  to  ulceration,  especially  if  neglected.  The  generally  relaxed  condition 
of  the  throat  is  partaken  of  by  the  uvula,  or  palate,  as  it  is  incorrectly 
called  by  many  people,  and  this  hanging  down  lower  than  it  ought,  may 
cause  a  hacking  cough  by  tickling  the  epiglottis. 

The  above  is  a  description  of  sore  throat  in  general.  The  most  com- 
mon form  of  inflammation  of  the  throat  is  tonsillitis. 

TONSILLITIS  OR  INTLAMMATION  OF  THE  TONSILS. 

Causes — The  disease  is  most  common  in  the  young.     It  is  rare  in 

infants.     Exposure  to  cold  and  wet  with  bad  hygienic  surroundings  seem 

to  be  the  chief  exciting  causes.     Some  writers  claim  that  there  is  a  close 

relation  between  this  and  rheumatism,  but  Osier  has  not  found  the  rela- 

?i6 


5G2 


DISEASES  OF   TilE  DIGESTIVE   SYSTEM. 


THE    TONGUE 


Figure  No.  i. 

i.  Hyoides     bone     joining     many 
muscles  of  the  tongue. 
2,  A  Muscles    fastened    at    the    cor- 
ners of  the  jaw-bone  to  pull 
in  the  tongue. 

3.  Muscle    formed    by    the    outer 

edge. 

4.  Deep    muscle    which    turns   the 

tongue  toward  the  side. 
5,6,7.  Muscles     which     facilitate     the 
turning    of    the    food    in    the 
mouth. 
8^8.  Salivary  glands. 

9.  Muscle    of    the   bottom    cf   the 

mouth. 
10.  Cross    muscle    formed    by    the 
l.p. 

Figure  No.  2. 

I,  1.  Muscles  which   form  the  outer 
border. 
2.  Hyoides  bone. 

3. 3.  Muscles   which   move   the   base 

of  tbe  tongue. 

4.4.  Exterior     insertion     of     trans- 

versal  muscles. 

5. 5.  Junction    line   of   the   transver- 

sal  muscles. 

Figure  No.  3. 

1.  Tonsils  or  glands  of  the  throat. 

2.  Base  of  the  epiglottis  or  valve 

to     close     the     windpipe     in 
swallowing. 

3.  Lateral  arches. 

4.  Muscles   joining  the   tongue  to 

the  epiglottis. 

5.  Blind  apertures  in  the  base  of 


the  tongfue  called  "blind  fora- 
men." 

7.  Nerve  endings  like  thread. 
8,9.  Fungiform  nerve  endings. 

10.  Apex  of  the  tongue. 

Figure  No.  4. 

1.  Exterior  muscle  of  the  tongue. 

2.  Apertures  of  mucous  glands. 

3.  Apex. 

4.  Under  muscles  with   the  cover 

removed. 

5.  Periglottis  turned  back. 

6, 7.  Conduits    at    the    base    of    the 
tongue. 

8.  Nerve  endings  at  the  base. 

9.  Salivary   glands. 

10.  Muscles   joining  the  tongue   to 
the  epiglottis. 
11,12.  Depressions     upon     the     peri- 
glottis. 

Figure  No.  5. 

1,2.  Salivary  conduits. 

3.  Wharton  conduits. 

4.  Sublingual  gland. 

5.  Branches  or  arms  of  the  jaw- 

bone. 

Figure  No.  6. 

I.  Nerve  endings  of  the  tongue. 
2,  2,  2.  Submucous  pellicle. 

3.  Muscular   larynx    (deep). 

4.  Band    which    joins    transversal 

muscles. 

5.  Transversal  bands  of  the  mus- 

cles. 
6,  6,  7,  7.  Salivary  conduits. 

8.  Muscles     for     pulling     in     the 
tongue. 


Fig.  1. — View  of  the  muscles  of  the 
tongue — lower  surface. 


Fig.  J. — Front  view  of  the  upper 
surface  of  the  tonpue;  as  also  of  the 
arch  of  the  bone  of  the  palate. 


Fig.    5. — View   of  the  lower  jav 
bone  witli  the  tongue  turned  up. 


Fig.  2. — View  of  the  under  surface 
of  the  tongue  with  its  musclesi 


Fig.  4. — View  of  the  back  of  the 
tongue,  from  which,  by  masceration. 
the  periglottis  has  been  removed  and 
turned  back  on  the  right  side. 


Fig.  6. — ^View  of  a  section  of  the 
front  part  of  the  tongue,  seen  from 
behind. 


THE  TONGUE. 

For  an  explanation  of  the  illustrations  see  text  on  opposite  page. 

563 


564  DISEASES   OF   THE   DIGESTIVE   SYSTEM. 

tiou  between  the  two  very  striking,  except  iu  one  point,  viz.,  "that  an 
attack  of  acute  rheumatism  is  not  infrequently  preceded  by  an  attack  of 
inllammation  of  the  tonsils.  Personal  susceptibility  and  heredity  play  an 
important  part  iu  its  productions.  At  times  it  runs  through  a  family, 
or  a  community,  with  such  rapidity  as  to  suggest  an  infectious  origin. 

Symptoms. — In  the  mild  forms  there  may  be  no  other  symptoms  than 
redness  and  dryness  of  the  throat  with  painful  swallowing.  The  tonsils 
may  be  felt  as  hard  lumps  just  behind  the  angle  of  the  jaw. 

Symptoms  of  More  Severe  Forms — In  the  more  severe  forms  it  may 
begin  with  a  chill  followed  by  a  rise  of  temperature  which  in  children 
may  reach  as  high  as  105  degrees  Fahrenheit.  Pains  in  the  back  and 
limbs  are  not  uncommon. 

local  Symptoms — The  local  symptoms  are  those  of  the  mild  form 
accentuated.  If  only  one  tonsil  is  swollen  the  uvula  is  drawn  to  the 
affected  side. 

Follicular  Form. — In  this  variety  white  patches  may  be  seen  covering 
the  tonsil.  These  are  due  to  the  accumulation  of  degenerated  epithelial 
and  white  blood  cells  in  the  depressions,  or  cryps,  in  the  tonsil. 

Dia^osis — The  follicular  form  must  be  distinguished  from  diph- 
theria. The  membrane  of  diphtheria  is  not  in  patches,  but  continuous 
over  the  surface  of  the  tonsils,  and  extended  up  itpon  the  pillars  of  the 
fauces  and  uvula,  and  is  greyish-white  in  color.  When  this  is  stripped 
off  it  leaves  a  raw,  bleeding  surface,  which  is  not  the  case  when  the  con- 
tents of  the  cryps  are  expressed  in  follicular  tonsillitis. 

Constitutional  Treatment — Bowels  must  be  freely  opened  with  calo- 
mel, one-quarter  grain  every  half  hour,  for  six  doses;  followed  by  mag- 
nesia sulphate  (epsom  salts),  one-half  ounce,  to  be  given  one  hour  after 
last  dose  of  calomel ;  ten  grains  of  Dover's  powder  at  bedtime.  Salicylate 
of  soda  is  often  beneficial,  and  may  be  given  as: 

R. — Salicylate   of   soda    5       drachms 

Iodide  of  potassium  2%  drachms 

Syr.    sarsaparilla    l'-^  ounces 

Water   sufficient  to   make   four   ounces.     Take   one   drachm 

every   four   hours.     The   dose   must   be   reduced    in   children   to 

about  half. 

Local  Treatment. — Gargles  of  borax,  ten  grains  to  the  ounce,  or  salt 
au'l  -ivater.  hot.     The  following  will  be  found  very  serviceable: 


QUINSY    OK   ABSCESS    0¥    TONSIL.  565 

R. — Tincture  chloride  of  iron   i  ounce 

Glycerine    i  ounce 

Chlorate   of  potash    Vi  drachm 

Shake  well  before  using,  and  use  one  drachm  of  the  mixture  to  one 
ounce  of  water,  as  a  gargle.     Clean  teeth  after  using. 

Sprays  of  glyco-thjonoline  or  supra-renal  extract  are  good;  or  swab 
throat  with  equal  parts  of  tincture  of  iron  and  glycerine. 

ariNSY  on  ABSCESS  OF  TONSIL. 

This  disease  is  a  cause  of  great  suffering  to  some  persons  in  youth 
and  middle  age,  but  is  rare  in  childhood,  and  often  ceases  its  molestations 
after  individuals  commence  the  decline  of  life. 

Causes. — Exposure  to  cold  and  wet  are  its  common  exciting  causes. 

Symptoms — In  the  catarrhal  form  of  quinsy  the  inflammation  is  often 
superficial,  and  after  causing  much  pain  and  difficulty  of  swallowing,  sub- 
sides in  three  or  four  days  without  suppuration.  In  the  severer  variety 
an  abscess  or  boil  forms  in  the  substance  of  the  tonsil,  attended  with 
great  pain  and  swelling,  difficulty  of  swallowing,  a  good  deal  of  fever,  and 
some  loss  of  strength.  The  patient  often  suffers  from  earache,  and  is 
somewhat  deaf  on  account  of  the  inflaimnation  extending  along  the  Eus- 
tachian tube.  The  breathing  through  the  mouth  is  much  interfered  with, 
but  the  danger  of  suffocation  is  apparent  only.  The  disease  lasts  on  an 
average  about  seven  days,  but  the  abscess  may  break  on  the  fifth  day,  or 
may  linger  until  the  teuth  day,  unless  earlier  oiieued  by  the  lancet.  The 
complaint  is  very  apt  to  recur,  and  the  sufferer  from  one  attack  rarely 
escapes  without  several  every  winter,  until  the  tendency,  which  may  be 
hereditary,  is  exhausted. 

Treatment — The  treatment  consists  m  an  effort  to  abort  the  disease 
by  leeching,  externally,  and  the  use  of  guaiacum  in  teaspoonful  doses  of 
the  tincture  four  times  daily,  by  the  mouth.  If  these  remedies  fail, 
poultices  of  little  bags  of  hops  dipped  in  hot  vinegar  and  sprinkled  Avith 
laudanum,  and  hypodermic  injections  of  a  quarter  of  a  grain  of  morphia, 
may  afford  some  relief.  When  suppuration  is  established,  the  period  of 
suffering  can  be  abbreviated  by  lancing  the  swelling  in  the  throat,  pro- 
vided the  spot  where  the  abscess  points  is  high  enough  to  be  felt  by  the 
finger.  The  operation  is  performed  by  having  a  long,  narrow-bladed 
knife  wrapped  with  sticking  plaster  to  within  a  quarter  of  an  inch  of  its 
poipt,  ^nd  then  passing  this  down  the  throat,  guarding  it  with  the  finger, 


566  DISEASES  OF   THE   DIGESTIVE   SYSTEM. 

and  giiidod  by  the  touch,  as  the  patient  can  rarely  open  the  mouth  wide 
enough  to  admit  of  seeing,  a  small  incision  is  made  into  the  softened  por- 
tion of  the  tumor.  The  relief  afforded  either  by  puncture  in  this  way, 
or  by  spontaneous  rupture,  is  wonderfully  great.  No  after-treatment  is 
necessary;  but  as  before  mentioned,  the  complaint  is  very  liable  to  recur, 
and  it  often  happens,  that  in  persons  who  are  strongly  predisposed  to  it, 
the  first  imprudent  exposure  on  venturing  out  will  light  up  the  disease 
in  the  opposite  tonsil,  with  an  almost  exact  repetition  of  the  suffering, 
within  two  weeks. 

DISEASES  OF  THE  (ESOPHAGIJS  OR  GULLET. 

Inflammation  of  the  Gullet — This  is  a  rare  affection,  and  usually 
due  to  swallowing  some  hot  or  corrosive  liquid,  although  it  may  occur  from 
the  extension  of  simple  or  erysipelatous  inflammation  from  the  throat, 
or  of  the  former  variety  from  the  stomach.  Ulceration  is  also  uncommon, 
although  it  does  occur  in  connection  with  syphilitic  complaints. 

Stricture  of  Gullet. — This  is  the  most  frequent  form  of  disease  of  the 
gullet. 

Varieties  of  Stricture — 1.  Spasmodic  stricture  is  a  narrowing  of  the 
tube,  caused  by  simple  contraction  of  its  muscular  fibres.  This  condition 
is  especially  met  with  in  hysterical  females,  and,  though  alarming  at  the 
time,  seldom  proves  fatal  to  life. 

Traumatic  Stricture — 2.  This  is  the  variety  in  which  the  constriction 
has  been  caused  by  irritation  and  inflammation  due  to  an  injury  inflicted 
on  the  surface  of  the  tube,  in  any  part  of  its  length,  by  the  swallowing 
of  scalding  water  or  of  some  corrosive  substance,  or  by  a  wound.  The 
result  of  such  a  stricture  is  to  render  the  act  of  swallowing  always  difficult, 
unless  relieved  by  a  surgical  operation. 

Simple  Organic  Stricture. — 3.  This  is  occasionally  seen,  in  which  there 
is  a  mere  narrowing  of  the  gullet,  without  any  apparent  tendency  to 
ulceration.  The  most  common  and  fatal  form  of  stricture  is  that  due  to 
cancerous  deposit  and  ulceration.  It  may  cause  death  by  producing  a 
complete  obstruction,  so  that  neither  food  nor  drink  can  enter  the  stomach, 
or  by  ulcerating  into  some  of  the  adjoining  vital  structures.  The  surgical 
operations  sometimes  performed  for  its  relief  are  of  very  doubtful  benefit 
or  propriety. 


IKFLAMMATION  OF  THE  STOMACH.  667 


ACUTE  GASTRITIS,  INTLAMMATION  OF  THE  STOMACH. 

The  simplest  and  most  common  form  of  inflammation  of  the  stomach 
is  characterized  by  active  congestion  and  excessive  secretion  of  mucus,  a 
condition  known  under  the  name  of  gastric  catarrh,  and  very  similar  to 
that  so  frequently  met  with  in  the  throat  and  air-passages. 

Causes.— The  causes  of  this  malady  are  indigestible  food,  especially 
in  children,  irritant  poisons,  or  alcoholic  excess.  But  it  may  occur  in  con- 
nection with  gout  or  as  a  symptom  in  some  of  the  eruptive  fevers. 

Symptoms — The  symptoms  of  acute  gastritis  are  pains,  which  are 
often  severe  over  the  pit  of  the  stomach,  shooting  through  to  the  back, 
and  increased  by  taking  food,  but  temporarily  relieved  by  vomiting. 
Tenderness  over  the  pit  of  the  stomach  is  always  present,  and  nausea 
and  vomiting  are  prominent  symptoms,  the  vomited  matter  consisting  of 
a  glairy  mucus,  stained  with  bile  of  a  greenish-yellow  or  bright  green 
color.  The  tongue  is  coated  with  fur,  whilst  the  edges  and  tip  are  fre- 
quently red  and  irritated.  The  bowels  are  apt  to  be  confined,  and  the 
urine  scanty  and  high  colored.  These  symi:)toms  often  set  in  with  chilli- 
ness, followed  by  restlessness,  hot  skin,  headache,  and  other  febrile  symp- 
toms. In  bad  cases  there  may  be  great  prostration,  with  cold,  clammy 
skin,  a  weak,  rapid  pulse,  some  difficulty  of  breathing,  and  obstinate 
hiccough.  Generally,  however,  under  proper  management,  these  distress- 
ing symptoms  subside  after  a  time,  although  they  sometimes  pass  into 
those  of  the  chronic  form  of  gastritis. 

General  Treatment. — The  treatment  of  this  disease  is,  in  the  first 
place,  if  consequent  upon  the  introduction  of  some  poison  or  irritating 
material,  to  get  rid  of  the  offending  substance  by  means  of  an  emetic, 
followed  by  a  purgative,  which  is  perhaps  in  most  cases  best  administered 
by  enema. 

Diet — The  food  should  be  entirely  liquid,  and  given  in  very  small 
quantities;  in  fact,  most  cases  woiild  do  better  if  nutritive  injections  were 
depended  on  to  sustain  life  for  a  few  days  or  a  week  or  two.  The  thirst 
may  be  relieved  by  sucking  small  pieces  of  ice,  but  iced  champagne  is 
sometimes  borne  by  the  stomach  when  everything  else  is  rejected,  and 
iced  carbonic-acid  water  is  often  acceptable. 

Medicinal  Treatment. — With  the  exception  of  subnitrate  of  bismuth, 
in  quantities  of  five  grains,  and  drop-doses  of  diluted  hydrocyanic  acid,  it 
is  usuallv  advisable  not  to  provoke  the  irritable  stomach  with  medicines, 


568  DISEASES   OF   THE   DIGESTIVE  SYSTEM. 

the  hypodermic  injection  of  morphia  being  used  to  relieve  the  pain,  if  the 
j)atient  can  take  morphia,  or  morphia  and  atropia,  ia  doses  of  one-eighth 
of  a  grain  of  the  former  and  one  one-hundredth  of  the  latter  in  that  way 
without  nausea  being  produced.  Thin  and  light  poultices,  as,  for  instance, 
of  flaxseed  meal  and  laudanum,  laid  over  the  region  of  the  stomach,  are 
frequently  of  service,  or  if  the  pain  is  very  severe  a  few  leeches  may  be 
ajjplied.  Convalescence  from  this  malady  is  generally  slow,  and  requires 
great  care  in  regard  to  diet  and  exertion. 

DYSPEPSIA. 

This  affection,  the  great  torment  of  civilized  life,  is  to  be  considered 
rather  as  an  unnatural  functional  difficulty  than  as  a  structural  disease. 

Varieties  of — Among  its  three  chief  varieties  may  be  mentioned: 

First  Form. — The  form  due  to  sympathetic  relations  with  other  organs 
which  are  themselves  in  a  morbid  state,  and  which  is  therefore  explainable 
as  a  reflex  action.  Of  such  a  type  is  the  nausea  and  occasional  vomiting 
which  attends  irritation  of  the  brain,  lungs,  liver  or  uterus.  Sea-sickness 
is  believed  to  be  a  form  of  this  reflex  dyspepsia. 

Second  Form. — This  form  is  attributable  to  a  scanty  secretion  of 
gastric  juice,  and  is  characterized  by  slowness  of  "digestion,  long  retention 
of  food  in  the  stomach,  prolonged  distress  after  eating,  especially  with 
feelings  of  weight  and  uneasiness  at  the  pit  of  the  stomach,  a  tendency 
to  decomposition  of  the  food  in  the  alimentary  canal  .with  the  evolution  of 
fetid  gases  and  the  appearance  of  undigested  food  in  the  evacuations  from 
the  bowels.  The  food  may  be  considered  to  be  delayed  in  the  stomach 
when  it  remains  there  for  more  than  two  or  three  hours.  Dyspepsia  of 
this  kind  is  often  inherited,  but  much  can  be  done  to  aggravate  the  ten- 
dency by  mental  over-exertion,  prolonged  and  intense  anxiety,  especially 
if  commencing  directly  after  meals,  sedentary  habits,  gluttony,  and  the 
use  of  alcoholic  and  other  stimulants. 

Third  Form — This  form  of  dyspepsia  appears  to  be  owing  to  some 
abnormal  quality  of  the  gastric  juice,  and  to  diminished  peristaltic  move- 
ment of  the  stomach,  so  that  food  is  not  sufficiently  "mixed  up  with  the 
digestive  fluids. 

Symptoms — One  of  the  most  characteristic  symptoms  of  this  con- 
dition is  pain  at  the  cardiac  end  of  the  stomach,  to  which  tlie  name  of 
cardialgia  has  been  applied,  on  account  of  tlie  distress  being  in  such  close 
proximity  to  the  heart.     Many  dyspeptics,  being  also  more  or  less  hypo- 


DYSPEPSIA.  569 

flionrlriacs,  imagine  from  this  symptom  that  they  are  subjects  of  organic 
disease  of  the  heart,  and  suffer  intense,  yet  groundless,  mental  anxiety  on 
that  account.  The  names  of  heartburn,  pyrosis  and  water-brash  are 
applied  to  slight  modifications  of  this  symptom.  Tobacco  contains  a 
poisonous  principle  which,  in  many  persons,  favors  the  development  of 
dyspepsia,  and  some  individuals  suffer  from  smoking  even  a  single  cigar. 

General  Symptoms. — Inability  to  absorb  liquids  occurs  in  some  vari- 
eties of  dyspepsia,  so  that  fluid  which  has  been  swallowed  may  be  heard 
splashing  around  in  the  gastric  cavity  on  any  foi'cible  agitation  of  the 
body,  the  stomach  being  usually  distended  to  a  great  extent.  As  further 
aids  in  distinguishing  between  dyspepsia  from  deficient  secretion  of  the 
gastric  juice,  and  deficient  motion  of  the  stomach,  it  should  be  remembered 
that  in  the  former  neither  flatulence  nor  constipation  are  generally  pres- 
ent, whilst  in  the  latter  variety  flatulence  is  one  of  the  most  characteristic 
symptoms  and  constipation  is  usually  well  marked.  Some  of  the  worst 
cases  of  dyspepsia  from  deficient  secretion  of  the  digestive  fluid,  in  which 
pain  after  taking  food  and  other  symptoms  are  particularly  severe,  ap- 
pear entirely  free  from  flatulence.  The  tendency  of  the  fermentation 
which  goes  on  in  the  slowly  digesting  food  seems  to  be  of  a  kind  in  which 
gases  are  not  evolved.  In  all  these  forms  there  is  a  loss  of  appetite.  The 
tongue  is  usually  broad,  pale  and  flabby.  The  pidse  is  weak,  soft  and 
compressible,  and  palpitation  of  the  heart  frequently  occurs.  There  may 
be  dyspnoea  on  exertion  and  a  short  dry  cough,  the  stomach-cough  of  the 
older  authors.  The  general  nutrition,  of  course,  suffers,  and  the  face  is 
pallid  and  bloodless  to  a  greater  or  less  degree. 

Treatment — ^Diet — 1.  The  treatment  of  dyspepsia  must  be  chiefly 
diatetic,  although  medicines  are  not  powerless  in  this  complaint.  In  the 
first  place  all  indigestible  food,  such  as  pork,  veal  and  salt  meats,  and 
richly-made  dishes,  such  as  pastry  of  every  description,  ought  to  be 
avoided.  In  the  acid  forms  of  dyspepsia,  which  are  connected  with  de- 
ficient muscular  movement,  pastry  and  saccharine  substances  are  par- 
ticularly harmful,  and  vegetables  and  fruit  should  be  partaken  of  spar- 
ingly. In  some  instances  an  exclusive  milk  diet,  persevered  in  for  some 
weeks,  has  appeared  to  produce  marvelously  good  results ;  but,  except  un- 
der such  a  regimen,  water  ought  to  be  the  habitual  drink.  Cocoa,  de- 
prived of  its  fatty  ingredients,  is  often  much  to  be  preferred  to  tea  and 
coffee,  and  those  accessory  foods,  if  taken  at  all,  should  be  weak,  cool  and 
well  diluted  with  milk.  Rich  or  effervescent  wines  should  be  avoided, 
but  the  lighter  Ehine  wines  or  ale,  or  extract  of  malt,  are  often  useful  in 


6t0  mSlCASES  OF  THE  DIGESTIVE  SYSTEM. 

atonic  dyspepsia,  with  impaired  movement  of  the  digestive  organs.  In 
order  to  improve  the  general  health  all  the  agencies  which  favor  the  im- 
provement of  the  nutrition  and  enrichment  of  the  blood,  snch  as  abun- 
dant exercise  in  the  fresh  air,  tepid  or  cool  bathing,  and  warm  clothing 
should  be  pressed  into  service.  The  successful  prescription  of  a  famous 
English  physician  to  a  rich  and  indolent  patient  who  came  to  him  com- 
plaining of  the  tortures  of  dyspepsia  was,  "Go  and  live  on  a  shilling  a 
day  and  earn  it." 

Medicinal  Treatment. — 2.  In  the  medicinal  treatment  for  dyspepsia 
acconi])anied  by  undue  acidity,  as  evidenced  by  the  frequency  of  heart- 
burn, if  the  urine  is  scanty  and  lets  fall  an  abundant  deposit,  alkalies,  such 
as  the  bicarbonate  of  soda  or  potash  in  quantities  of  ten  to  twenty  grains 
thrice  daily,  are  useful,  and  are  best  taken  three  or  four  hours  after  a 
meal.  In  acidity  with  anemia  and  debility,  mineral  acids,  such  as  the 
diluted  nitro-hydrochloric  in  five-drop  doses,  serve  the  purpose  better. 
Vegetable  bitters,  of  which  columbo  in  doses  of  a  wineglassful  of  the 
infusion  thrice  daily  generally  proves  the  mildest,  and  nux  vomica  or 
strychnia  are  good  digestive  tonics,  and  in  slow  digestion  benefit  is  some- 
times derived  from  very  minute  doses  of  ipecacuanha. 

A  good  prescription  is: 

R. — Tincture  nux  vomica    4  drachms 

Tincture    cinchona    2  ounces 

Tincture  gentian    2  ounces 

Simple   cUxir    2  ounces 

Teaspoonful  three  times  a  day. 

For  vomiting,  besides  the  remedies  already  spoken  of  under  gastritis, 
very  small  quantities  of  Fowler's  solution  of  arsenic,  in  two-drop  doses, 
or  creosote  mixture  may  be  tried.  For  flatulence  the  aromatic  carmini- 
tives,  such  as  ginger  and  cardamon,  and  powders  of  two  grains  each  of 
charcoal  with  bismuth,  also  coimter-irritation  by  means  of  small  blisters 
over  the  stomach  are  often  of  gi-eat  service.  When  the  secretion  of  gastric 
juice  is  scanty,  pepsin  or  lactopeptine,  in  quantities  of  ten  grains,  fre- 
quently proves  itself  invaluable  as  an  aid  to  digestion;  or  a  prescription 
containing : 

R. — Dilute  hydrochloric  acid    2%  drachms 

Pepsin    (soluble)     2      drachms 

Glycerine    i      ounce 

Elix.   aromatica    2      ounces 

Water,  sufficient  quantity  for   4      ounces 

Take  one  drachm  of  the  mixture  in  water  three  times  a 
day.     Best  taken  through  glass  tube. 


TTLOEB  OF  THE  STOMACH.  571 


CANCER  OF  THE  STOMACH. 

The  stomach  is  one  of  the  most  frequent  seats  of  cancer,  which  is 
especially  apt  to  attack  this  organ  in  men  advanced  in  life  who  have  sub- 
jected their  digestive  apparatus  to  more  or  less  constant  irritation.  The 
tendency  is  very  often  hereditary.  The  cardiac  end  of  the  stomach  is 
generally  the  seat  of  epithelial  cancer,  and  the  pyloric  extremity  of  hard 
cancer  or  scirrhus.  Its  tendency  is  to  extend  aroimd  the  organ,  and  hence 
it  leads  to  an  annular  or  ring-like  constriction. 

Symptoms. — The  symptoms  are  those  of  gastritis  or  mere  dyspepsia 
at  first,  but  after  a  few  weeks  or  months,  in  a  majority  of  instances,  a  small 
amount  of  blood  is  vomited,  and  serves  to  indicate  pretty  clearly  the  true 
nature  of  the  case.  The  blood  in  cancerous  hematemesis  of  this  kind 
being  effused  slowly  and  in  small  quantity  is  altered  by  the  action  of  the 
gastric  juice  so  as  to  present  a  brown  color.  This  tint  and  the  minute 
clots  in  which  it  appears  have  caused  the  expressive  name  of  coffee  ground 
vomit  to  be  applied  to  it.  Although  not  an  infallible  sign,  it  constitutes 
one  of  the  surest  early  evidences  we  possess  of  the  existence  of  cancer  of 
the  stomach.  This  disease  is  distinguished  from  gastric  ulcer,  which  it 
most  resembles,  by  its  occurrence  in  advanced  life  instead  of  in  the  young; 
by  the  presence  of  a  hereditary  predisposition;  by  the  character  of  the 
hematemesis ;  by  the  greater  diffusion  of  the  tenderness ;  by  the  constancy 
of  the  pain ;  by  the  cancerous  cachexia,  and,  as  emaciation  advances,  by  the 
increasing  tumor,  which  can  be  distinctly  felt  in  most  cases  through  the 
thinned  walls  of  the  abdomen.  The  average  duration  of  cancer  of  the 
stomach  is  from  six  months  to  one  year,  and  it  always  proves  fatal. 

Treatment. — The  only  treatment  which  offers  any  hope  of  recovery 
ia  surgical. 

ULCER  OF  THE  STOMACH. 

Causes. — This  remarkable  disease  is  attributed  to  the  corroding  action 
of  gastric  juice  on  the  very  membrane  which  has  secreted  it,  in  con- 
sequence of  the  vitality  of  that  membrane  becoming  impaired  by  throm- 
bosis of  some  small  artery  in  the  wall  of  the  organ.  Disorder  of  menstrua- 
tion may  develop  an  ulcer,  tight  lacing  or  any  occAipation  which  necessi- 
tates constant  leaning  over,  as  in  shoemaking  or  tailoring.  It  is  more 
common  in  females  than  males,  and  is  more  frequent  in  young  women 
than  those  of  middle  or  advanced  age.     Traumatism  or  swallowing  any 


572  DISEASES   OF   THE   DIGESTIVE   SYSTEM. 

corrosive  substance  may  lead  to  ulceration.  Anderson  believes  that 
alcoholism,  pvphilis  or  mental  worry  may  lead  to  the  condition. 

Appearance. — A  simple  gastric  ulcer  is  round  or  oval,  about  one- 
quarter  to  one-half  an  inch  in  diameter,  veith  thin,  clean-cut  margins  as 
if  punched  out,  but  deepest  in  the  centre,  like  a  shallow  funnel,  though 
varying  in  depth  from  a  mere  destruction  of  the  mucous  membrane  to 
complete  perforation  of  all  the  coats.  It  is  usually  single  and  most  com- 
monly situated  at  the  back  of  the  organ  near  its  lower  or  pyloric  oritice. 
The  ulcer  may  happen  to  eat  into  some  large  blood-vessel,  in  which  case 
serious  or  fatal  hemorrhage  is  apt  to  occur. 

Terminations. — The  terminations  of  such  an  ulcer  are  the  favorable 
ones  of  its  healing  up  with  or  without  puckering  in  the  wall  of  the  stomach, 
or,  on  the  other  hand,  of  perforation,  which  may  occur  with  the  escape  of 
the  contents  of  the  stomach  into  the  peritoneal  cavity.  Such  an  accident 
is  generally  followed  by  peritonitis  and  almost  certain  death. 

Symptoms. — The  symptoms  of  gastric  ulcer  are  pain  and  tenderness 
over  the  pit  of  the  stomach,  this  pain  coming  on  shortly  after  taking  food, 
and  increasing  until  the  organ  is  emptied  by  vomiting.  Sometimes  the 
distress  seems  to  extend  through  into  the  back.  The  seat  of  tenderness 
coincides  with  that  of  pain,  and  is  localized  over  a  comparatively  small 
surface.  Vomiting  of  blood  occurs  in  about  one-third  the  cases,  and 
though  not  so  frequent  as  in  cancer  is  much  more  profuse.  It  may  be 
either  in  black  clots  or  fresh  blood,  and  not  infrequently  blood  is  passed 
by  the  bowels.  Vomiting  of  food  half  an  hour  or  an  hour  after  eating  13 
usual,  and  various  dyspeptic  symptoms  are  met  with.  The  pain  is  often 
described  by  the  patient  as  of  a  gnawing  character,  and  is  commonly  made 
worse  by  condiments,  animal  food,  saccharine  substances  and  alcohol ; 
whilst  the  pain  in  neuralgia  of  the  stomach  is  frequently  relieved  by  these 
articles  of  diet. 

Medicinal  Treatment — The  most  successful  treatment  of  gastric  ulcer 
is  ])erfect  rest  in  bed  and  nourishment  entirely  by  nutritive  injections,  for 
a  period  of  from  one  to  three  weeks,  or  until  the  subsidence  of  the  pain 
and  tenderness  indicate  the  healing  of  the  ulcerated  spot.  Prussic  or 
hydrocyanic  acid  and  bismuth,  as  directed  in  gastritis,  may  be  given  to 
control  vomiting,  and  morphia  hypodermically,  guarded  if  needful  by 
atropia,  to  relieve  pain.  Stomach  should  be  washed  out  twice  a  day. 
Small  blisters  over  the  stomach  are  frequently  useful,  and  the  first 
food  administered  should  be  lime-water  and  milk  in  very  small  quantities, 
gradually  increased  as  the  power  of  the  organ  to  retain  food  is  found  to 


PEEITONITIS.  573 

be  restored.  If  vomiting  of  blood  comes  on,  perfect  rest,  the  quieting  of 
the  peristaltic  motion  of  the  stomach  and  whole  digestive  tube  by  full 
doses  of  a  grain  every  two  hours  of  opium,  or  one-sixth  of  a  grain  of 
morphia,  and  the  use  of  acetate  of  lead  by  the  stomach  in  qiiantities  of 
two  grains  every  three  hours,  tannic  acid  and  gallic  acid  by  enema,  and 
five  grains  of  ergotin  hypodermically,  are  to  be  resorted  to.  Ice  in  small 
pieces  may  be  given  frequently,  and  cold  cloths  apjilied  over  the  gastric 
region.    Perforation  is  indicated  by  severe  pain  and  shock. 

Surgical  Treatment. — If  the  patient  grows  worse  in  spite  of  medical 
treatment,  if  hemorrl)age  is  profuse,  if  pain  is  severe,  or  if  the  tenderness 
is  marked,  surgical  treatment  must  be  resorted  to  and  should  only  be  done 
by  a  skilled  surgeon.  A  number  of  cases  of  perforation  and  hemorrhage 
have  been  saved  by  a  surgical  operation. 

PERITONITIS. 

Character — This  dangerous  malady  is  an  inflammation  of  the  perito- 
neum or  serous  sac  covering  the  intestines,  liver,  spleen,  and  so  forth,  and 
reileeted  upon  the  inner  surface  of  the  wall  of  the  abdomen.  It  is  prob- 
ably more  liable  to  become  quickly  and  violently  inflamed  than  any  other 
structure  of  the  body.  It  may  be  either  general  or  local.  Local  perito- 
nitis may  occur  whenever  any  of  the  organs  of  the  abdominal  cavities  be- 
come the  seat  of  inflammation. 

Causes — 1.  Exposure  to  wet  and  cold. 

2.  Traumatism. 

3.  It  may  result  from  the  perforation  of  an  ulcer  occurring  in 
stomach,  intestines  or  liver. 

4.  Inflammation  of  the  uterus  following  confinement  and  constitut- 
ing child-bed  fever,  which  we  see. 

5.  It  may  be  secondary  to  some  morbid  disease  as  tuberculosis,  rheu- 
matism or  Bright's  disease. 

Symptoms. — A  chill  with  moderate  fever,  rapid  pulse,  intense  ab- 
dominal pain,  abdominal  rigidity,  painful  respiration.  The  patient  lies 
with  thighs  flexed,  features  are  pinched,  vomiting  persistent  and  bowels 
are  usually  constipated. 

Treatment. — Absolute  rest  is  essential.  Restrict  the  diet.  Give  fre- 
quent doses  of  opium,  one  grain,  or  morpliine,  one-quarter  grain.  Hot  or 
cold  applications  to  the  abdomen.     In  non-perforating  cases  give  saline 


574  DISEASES  Oil'   THE   mOESTlVE   SYSTEM. 

purge.      In   perforating  cases,   which   are   the   most  frequent,   a   surgical 
operatiou  offers  the  only  hope. 

ENTERITIS  OR  INELAMMATION  OF  THE  BOWELS. 

Symptoms. — This  disease  is  not  very  common,  but  may  arise  from 
taking  cold,  from  the  abuse  of  purgatives,  from  swallowing  or  inhaling 
irritant  poisons,  and  from  peritonitis.  Its  symptoms  are  diarrhoea  with 
pain,  often  very  severe,  increased  on  pressure  and  most  intense  about  the 
navel  or  in  the  right  flank.  The  frequent  discharges  temporarily  relieve 
the  gi'iping  jiains,  which,  however,  soon  return.  The  pulse  is  excited, 
generally  full  and  strong  and  marked  fever  is  present. 

Treatment — The  treatment  is  by  anodyne  fomentations  or  poultices 
to  the  abdomen,  such  as  the  flaxseed  poultice  with  laudanum,  and  grain 
doses  of  opium  by  enema  or  suppository.  Kest  in  bed  must  be  strictly 
enjoined. 

COLITIS. 

Acute  dysentery,  bloody  flux,  an  acute  inflammation  of  the  mucous 
membrane  of  the  large  intestine,  generally  catarrhal,  characterized  by 
fever  and  sometimes  followed  by  ulceration.  The  causes  are  summer  and 
autumn  seasons,  sudden  changes  in  the  atmosphere,  errors  in  diet,  impure 
drinking  water,  etc. 

Symptoms. — Begins  gradually  with  diarrhoea,  loss  of  appetite,  nausea 
and  slight  fever,  which  continues  for  two  or  three  days.  When  the  dysen- 
tery symptoms  develop,  pain  on  pressure  along  the  colon,  colicky  pains 
about  the  navel,  burning  in  the  rectum,  and  a  desire  to  expel  it  or  tenesmus, 
stools  contain  mucus  and  blood,  urine  scanty  and  high  colored,  duration 
about  one  week,  patient  emaciated.  This  may  lead  on  to  a  chronic  con- 
dition. 

Treatment.- — Patient  should  bo  confined  to  bed,  even  in  mild  cases. 
Discharges  should  be  disinfected  with  chlorinated  lime,  diet  should  be 
bland  and  unirritating.  Milk  and  lime-water,  broths,  egg  albumen.  Be- 
gin treatment  with  a  dose  of  castor  oil.  or  if  fever  is  high  epsom  salts,  two 
drams,  or  four  drams  of  rochelle  salts,  until  copious  discharge,  for  the 
pain  and  tenesmus.  Opium  in  some  form,  or  one-lwlf  grain  extract  opium 
and  two  grains  sugar  of  lead  every  two  or  three  hours,  or: 


APPENDICITIS.  57S 

R. — Dil.    sulphuric    acid    %  ounce 

Tr.  opii.  deod I  ounce 

Spirits    camphor    I  ounce 

Tr.   capsicum    %  ounce 

Spirits   chloroform    V2  ounce 

Brandy     I  %  ounces 

One  teaspoonful  diluted  every  two  or  three  hours. 

Twenty  to  thirty  grains  of  subnitrate  of  bismuth  is  also  valuable 
every  two  or  three  hours  during  convalescence.  Cod  liver  oil,  syr.  of 
lacto  phosphate  of  lime  and  the  following  are  effective: 

R. — Strych.    sulphate    %  grain 

Acid   muriatic    dil 2  ounces 

Tr.   gentian   co.   aJ 4  ounces 

Teaspoonful  in   water  before  meals. 

APPENDICITIS  OR  INFLAIOIATION  OF  THE  APPENDIX. 

Function  of  Appendix — Appendicitis  is  the  term  applied  to  inflamma- 
tion of  the  vermiform  appendix.  It  is  almost  invariably  the  primary 
lesion  of  all  those  various  conditions  known  as  typhlitis  or  perityphlitis, 
terms  which  are  well  relegated  to  obscurity.  The  appendix  is  a  small 
tube  or  diverticulum  coming  off  from  the  postero-interual  i)art  of  the 
caecum  or  beginning  of  the  large  bowel,  and  has  no  function  in  man.  but  in 
herbivora  and  rodents  is  a  functionally  active  organ.  The  jiosition  of  the 
appendix  corresponds  about  to  a  point  two  inches  from  the  anterior  spine 
of  the  pubis  on  a  line  down  from  the  spine  to  the  umbilicus.  This  point 
is  known  as  McBumey's  point. 

Causes — At  one  time  it  was  supposed  that  foreign  bodies,  as  seeds, 
pins,  etc.,  were  important  etiological  factors  in  the  production  of  the 
disease,  but  Fits'  statistics  show  that  only  twelve  per  cent,  of  cases  are 
caused  by  foreign  bodies.  Appendicitis  is  a  bacterial  disease,  usually  pro- 
duced by  the  bacteria  which  are  nominally  present  in  all  parts  of  the 
gastro-intestinal  tract,  which  have  a  powerfiil  action  when  the  vitality  of 
the  appendix  becomes  impaired  from  any  cause,  as  when  the  deverticulum 
is  bruised,  obstructed,  or  in  a  state  of  catarrhal  inflammation. 

Where  non-traumatic  inflammation  occurs  the  swelling  of  the  mucous 
membrane  occludes  the  tissues,  obstructing  the  full  communication  be- 
tween the  appendix  and  ccecuni,  and  the  appendix  becomes  converted  into 
a  closed  sac.  Dieulafoy  maintains  forcibly  that  appendicitis  is  always 
caused  by  the  conversion  of  tlie  appendix  into  a  closed  cavity.     Partial 


576  DISEASES    OF    THK    IIIGKSTIVK    SYSTEM. 

obstruction  may  be  caused  by  calculi,  which  are  composed  of  fecal  ma- 
terial mixed  with  salts  of  lime  or  magnesia.  These  calculi  are  not  formed 
in  the  colon  but  in  the  appendix.  Pozzi  believes  that  appendicular  colic 
may  be  caused  by  bending  of  the  appendix,  and  holds  that  pain  may 
arise  when  there  is  no  lesion  of  the  appendix.  A  foreign  body  may  pro- 
duce immediate  perforation,  giving  rise  to  a  diffuse  septic  peritonitis. 
Where  the  lesion  of  the  appendix  is  occluded  it  begins  to  swell  and  be- 
comes very  much  congested,  the  blood  supply  becomes  lessened  or  cut  off 
entirely.  The  microbes  multiply  with  great  rapidity  and  the  wall  of  the 
appendix  may  become  gangrenous,  or  it  may  ulcerate  and  perforate.  In- 
terference with  the  blood  supply  of  the  appendix  will  predispose  to  ap- 
pendicitis. 

When  the  appendix  becomes  inflamed  gradually,  the  peritoneum 
around  it  partakes  of  the  process  and  adhesions  are  usually  formed,  thus 
walling  off  the  appendix.  In  a  case  of  this  kind,  if  perforation  should 
occur  or  the  inflammation  go  to  the  formation  of  pus,  the  adhesion  would 
protect  the  general  peritoneal  cavity  from  the  poisonous  materials. 

Who  Are  Most  Subject — Appendicitis  occurs  most  frequently  in 
males,  as  the  blood  supply  is  more  abundant.  It  is  rare  in  infants,  but 
occurs  most  frequently  between  the  ages  of  sixteen  and  thirty  years. 
Appendicitis  that  subsides  may  at  any  time  recur,  and  the  life  of  the 
patient  is  under  constant  menace.     It  always  recurs  after  a  second  attack. 

Varieties. — Appendicitis  is  divided  into  the  catarrhal,  obliterative, 
suppurative  and  gangrenous  forms,  but  as  a  matter  of  fact  appendicitis 
is  always  one  disease  which  varies  in  intensity,  and  it  is  useless  to  divide 
it  into  a  number  of  symptomatic  groups. 

Symptoms. — 1.  In  what  is  known  as  appendicular  colic  there  are 
colicky  pains  in  the  right  iliac  region  most  marked  over  MeBurney's 
point,  but  radiating  towards  the  umbilicus,  nausea,  vomiting  and  usually 
constipation,  but  no  tenderness  in  the  right  iliac  fossa  or  abdominal 
rigidity. 

2.  In  a  genuine  case  of  appendicitis  the  patient  feels  listless  and  out 
of  sorts  for  two  or  three  days  before  the  attack,  loss  of  appetite,  furred 
tongue,  foul  breath  and  constipation  is  the  rule,  but  in  exceptional  cases 
there  may  be  diarrhoea. 

3.  The  onset  is  usually  with  colicky  pains  which  at  first  may  be 
general  over  the  whole  abdomen  but  most  intense  over  MeBurney's  point. 
Circumscribed  tenderness  over  ]\IcBurney's  point  and  across  may  be  felt. 


APPENDICITIS.  5Y7 

There  is  moderate  fever,  and  vomiting  is  usually  present  with  constipa- 
tion, abdominal  muscular  rigidity. 

4.  As  the  attack  progresses  the  fever  becomes  more  intense,  radi- 
ating towards  the  umbilicus  and  the  tenderness  over  McBurney's  point 
recrosses.  The  pulse  increases  and  fever  rises,  vomiting  becomes  worse, 
respiration  more  rapid  and  thoracic  in  character.  The  patient  lies  upon 
the  back  with  right  leg  drawn  up.  The  urine  is  scanty  and  highly  colored. 
Any  case  may  become  suddenly  desperately  grave  because  of  perforation 
or  gangrene. 

Terminations — Appendicitis  may  terminate  in  recovery,  in  death,  or 
in  a  condition  of  lowered  vitality,  renewed  attacks  being  certain  to  occur.' 

Treatment. — 1.  In  appendicular  colic  apply  a  hot  water  bag  over 
McBurney's  point,  give  a  saline  cathartic  and  watch  patient  for  fur- 
ther symptoms. 

2.  Many  surgeons  give  a  cathartic  in  undoubted  eases  of  appendicitis, 
but  the  increased  peristalsis  and  tension  caused  is  liable  to  give  rise  to 
perforation. 

3.  In  a  genuine  case  of  appendicitis  perfect  rest,  liquid  diet,  ice  bag 
to  McBv.rney's  point.  Do  not  use  opivnn  in  any  form-  as  it  masks  the 
symptoms.     If  the  symptoms  are  not  better  in  thirty-six  hours,  operate. 

4.  McBurney  says,  if  six  hours  after  the  beginning  of  the  attack  the 
patient  is  no  worse  there  is  no  pressing  danger,  if  in  twelve  hours  symp- 
toms are  not  intensified  they  will  soon  begin  to  abate,  but  if  in  twelve 
Lours  the  symptoms  have  become  worse,  operation  is  necessary. 

5.  It  is  always  better  to  operate  in  the  interval  between  the  attacks 
than  during  an  attack.  It  is  not  safe  to  delay  operation  in  a  pus  case.  It 
must  be  remembered  that  the  mildness  of  the  symptoms  is  no  assurance 
that  even  in  an  hour  or  two  gangrene  or  perforation  will  not  occur. 

A  person  of  generally  good  health  who  suffers  for  some  time  with 
vague  digestive  troubles  may  find  himself  a  victim. 

Pain  occurs  in  the  right  side  of  the  abdomen  between  the  ribs  and 
the  hip.  It  is  accompanied  by  colicky  paroxysms,  inore  or  less  violent, 
which  may  or  may  not  be  followed  by  vomiting  of  food  or  bile.  The 
colic  eventually  subsides,  but  a  fixed  pain  continues,  sometimes  exactly 
limited  to  the  point  of  the  appendix  and  sometimes  spreading  more  or 
less  over  the  bowels.  The  muscles  of  the  appendix  region  become  hard. 
Usually  there  is  but  little  fever. 

Notwithstanding  the  general  opinion  of  physicians  that  operation  is 
necessary,  there  are  many  eminent  medical  men  who  are  of  the  opinion 
37. 


678  DISEASES   OF   THE   DIGESTIVE  SYSTEM. 

that  appendicitis  is  in  many  cases  open  to  medical  treatment  capable  of 
effecting  cure.  The  following  prescription  is  one  of  the  best  which  has 
been  compounded  for  this  trouble. 

Cascara  Compound. 

Cascarin Ya  grain 

Aloin 14  grain 

Podyphyllmn 1/G  grain 

Ext.  Bella  Leaves y^  grain 

Strychnine  Sulph 1/60  grain 

Oleresin  Ginger %  grain 

Take  one  at  night  or  night  and  morning. 

All  drastic  cathartics  must  be  avoided.  The  prescription  just  given 
should  properly  regulate  the  bowels.  It  is  intended  to  remove  all  gases, 
sweeten  the  stomach  and  aid  digestion.  It  is  claimed  on  high  authority 
that  it  will  prevent  appendicitis  and  surgical  operation  if  it  is  taken  in 
due    time. 

Rest  is  necessary  and  the  intestines  should  be  kept  in  a  quiet  condi- 
tion. An  ice  cap  may  be  applied  over  the  seat  of  the  pain.  It  is  advisable 
that  the  patient  go  to  bed  and  assume  such  position  as  will — so  far  as 
possible  relax  the  abdominal  muscles.  Abdominal  movements  such  as 
may  be  caused  by  sneezing,  coughing,  etc.,  should  be  avoided.  The  diet 
at  first  should  consist  only  of  small  quantities  of  cold  or  lukewarm  milk, 
oatmeal,  bouillon,  etc. ;  avoid  meat  and  starchy  foods.  It  is  held  by 
some  that  there  is  great  virtue  in  the  external  use  of  kerosene  oil  in  cases 
of  appendicitis.  If  unfavorable  conditions  continue,  or  attacks  are  fre- 
quent, the  appendix  should  be  removed.  We  recommend  consultation  with 
physician  without  delay. 


INTESTINAL   OBSTRUCTION. 

This  term  is  applied  to  the  obstruction  of  any  part  of  the  intestinal 
canal      It  may  be  acute  or  chronic. 

Causes. — Obstruction  may  be  caused  : 

1.  By  a  band,  which,  becoming  looped  or  attached  to  one  or  more 
organs,  forms  a  noose  through  which  the  intestine  slips.  This  manner 
of  compression  is  known  as  strangulation. 


DTSENTEET.  B7S 

2.  By  one  portion  of  gut  slipping  into  another.  This  is  known  as 
intussusception  or  invagination. 

3.  By  kinking  of  the  gut. 

4.  By  the  narrowing  of  the  lumen,  Ly  contraction  of  scar  tissue  or 
the  encroachment  of  tumors. 

5.  By  the  pressure  of  foreign  bodies  large  enough  to  obstruct  the 
lumen. 

Symptoms  of  Acute  Obstruction  or  Complete  Obstruction The  active 

symptoms  are  usually  preceded  by  a  period  of  constipation,  with  a  feeling 
of  lassitude,  furred  tongue  and  foul  breath. 

1.  Pain  comes  on  abruptly,  first  colicky,  then  continuous  and  intense. 

2.  Vomiting  quickly  supervenes  and  is,  first,  of  the  stomach  contents, 
then  bilious,  and  finally  fecal. 

3.  Abdominal  distension  occurs  if  the  obstruction  is  in  the  lower 
bowel,  but  may  not  be  present  if  the  obstruction  is  high  up.  Constitu- 
tional symptoms  are  those  of  shock.  Thirst  is  intense,  urine  scanty  and 
highly  colored. 

Symptoms  of  Chronic  or  Partial  Obstruction Spnptoms  appear  grad- 
ually with  the  increase  of  the  narrowing  until  there  is  complete  obstruc- 
tion, or  the  s\inptoms  of  acute  obstruction  occur  from  time  to  time. 

Treatment — Purgatives  are  contra-indicated.  Pood  must  bo  with- 
held and  nutrition  given  only  by  the  rectum.  Give  opium  or  morphine  for 
the  pain  in  doses  of  one  grain  of  the  former  and  one-quarter  grain  of  the 
latter. 

Accessory  Treatment. — Washing  out  the  stomach  twice  a  day  to  con- 
trol the  vomiting.  Distension  of  the  bowel  with  gas  or  water  should  be 
practiced  in  doubtful  cases  and  in  intussusception.  Senn  recommends  the 
infiltration  of  hydrogen  gas.  If  these  methods  fail  to  relieve  the  obstruc- 
tion a  surgical  operation  must  be  done  at  once. 

DYSENTERY. 

This  is  a  febrile  disease,  characterized  by  severe  colicky  pains,  fol- 
lowed by  straining,  which  I'esults  in  scanty  mucous  or  bloody  stools,  con- 
taining little  or  none  of  the  natural  fecal  matter  or  excrement. 

Causes. — It  is  especially  prevalent  in  warm  climates,  and  warm 
weather  and  bad  hygienic  surroundings  play  an  important  role  in  its 
production.  Indigestion  of  irritating  foods,  exposure  to  cold  or  wet,  cer- 
tain debilitated  states,  as  scurvy,  Bright's  disease,  etc.,  seem  to  be  pre- 


580  DISEASES   OK   TIIK   DIGESTIVE   SYSTEM. 

disposing  causes  ainl  may  alone  produce  the  simple  form.  Tlie  tropical 
form  is  due  to  an  animal  parasite,  the  amoeba  coli. 

Symptoms — There  is  moderate  fever,  severe  colicky  pains  in  the  ah- 
c'.omen,  jH'ostration,  tenesmiis  or  straining,  constant  desire  to  defecate  with 
small  mucus  and  bloody  stools.  These  symptoms  are  aggravated  during 
the  night  and  early  morning,  and  leave  behind  them  the  tormenting  sensa- 
tion that  there  ahvays  remains  in  the  bowels  something  which  has  yet  to 
be  discharged.  This  sensation,  which  is  technically  called  tenesmus,  in- 
creases, and  ultimately  becomes  the  most  striking  feature  of  the  disease. 
^Yhen  the  malady  is  fully  established,  the  evacuations  consist  of  bloody 
slime,  sometimes  tinged  with  bile,  and  containing  shreds  of  membranous- 
like  exudation  th^o^vn  off  from  the  interior  of  the  bowels.  They  exhale 
an  odor  almost  peculiar  to  dysentery,  very  offensive  and'yet  quite  different 
from  that  of  ordinary  feces.  This  complaint  may  prove  fatal  in  con- 
sequence of  the  great  loss  of  blood,  but  it  more  commonly  causes  death  by 
wearing  out  the  patient. 

Other  Symptoms. — When  a  fatal  termination  threatens,  the  symptoms 
assume  a  typhoid  character,  with  great  iJrostration,  dry,  brown  tongue, 
hiccough  and  vomiting.  In  favorable  cases  improvement  begins  about 
the  end  of  the  first  week,  but  convalescence  is  usually  very  protracted,  and 
many  cases  stop  half  way,  as  it  were,  continuing  to  suffer  for  months 
or  years  with  the  chronic  form  of  the  affection. 

Common  to  Children. — This  disease  is  very  common  among  young 
children,  being  especially  prevalent  and  fatal  among  those  who  are  cruelly 
kept  in  cities  during  the  hot  summer  months,  and  it  is  the  usual  result  of 
starvation  or  deterioration  of  food,  especially  if  long  continued  and  ac- 
companied by  hardship  and  privation,  being  then  an  extension  of  the 
diarrha-a  which  is  apt  to  be  first  produced. 

Treatment — A  mild  laxative  is  indicated  in  the  beginning  as  epsom 
salts,  three  drachms,  or  castor  oil  and  laudanum  might  be  selected.  Bis- 
muth is  a  valuable  remedy.  Absolute  rest  in  bed  and  bland,  non-irritating 
liquid  diet.     The  following  may  be  found  useful: 

R. — Sulphat   of   morphia    Vj  grain 

Bismuth 40  grains 

Creosote    15  drops 

Simple    syrup    2  ounces 

A  teaspoon  ful  every  three  liours. 

After  the  more  violently  acute  stage  has  passed,  laudanum  injections. 
or  opium  by  suppositories,  with  such  astringents  as  two  grains  of  acetate 


DIAKEHCEA.  581 

of  lead,  half  a  grain  of  nitrate  of  silver,  and  of  sulphate  of  copper  com- 
bined with  small  doses  a  quarter  or  half  a  grain  of  opium  by  the  mouth, 
are  generally  beneficial,  but  care  must  bo  taken  not  to  check  the  disease 
too  suddenly  by  the  use  of  these  remedies. 

Additional  Treatment. — Flushing  out  the  bowels  with  a  saline  solu- 
tion may  be  tried,  or  starch  water  containing  one  grain  of  opium  may  be 
found  beneficial.  Hot  fomentations  over  the  abdomen  may  be  used  to 
relieve  the  pain.  Injections  of  warm  solutions  of  quinine,  1-5000  have 
been  used  in  dysentery  with  advantage.  Creolin,  a  drachm  to  the  pint, 
has  given  good  results. 

Diet. — The  diet,  as  pointed  out  before,  should  consist  of  the  blandest 
and  most  unirritating  substances,  such  as  boileil  milk  with  lime-water,  beef 
essence,  boiled  rice,  and  if  the  debility  is  extreme,  raw  eggs  beaten  up 
with  milk.  Stimulants  should  not  be  administered  unless  absolutely  neces- 
sary, on  account  of  their  locally  irritating  effect. 

DIARRHCEA. 

Causes — In  many  cases  this  conmion  malady  is  also  rather  a  con- 
sequence or  symptom  of  some  morbid  condition  than  itself  a  disease.  The 
frequent  discharge  of  loose  or  fluid  evacuations  from  the  bowels,  without 
griping  pain  or  tenesmus,  is  sometimes  a  wise  effect  of  nature  to  get  rid 
of  some  injurious  or  indigestible  material,  which  has  been  imprudently 
swallowed  into  the  stomach  and  has  from  there  passed  into  the  bowels. 
Diarrhoea  may  likewise  be  produced  by  some  violent  mental  impression, 
or  by  exposure  to  taking  cold,  the  bowels  instead  of  the  throat  being  often 
the  weak  spot  of  the  Individual.  It  also  results  from  privation  of  food, 
food  of  poor  quality,  and  many  analogous  causes. 

Medicinal  Treatment — In  the  treatment  of  diarrhoea  from  Indigest- 
ible food  no  attempt  should,  as  a  rule,  be  made  at  first  to  check  it  until 
the  offending  material,  whatever  it  may  be,  is  cast  out  of  the  system. 
In  fact,  a  gentle  and  soothing  laxative,  such  as  a  dose  of  castor-oil  with  a 
few  drops  of  laudanum  to  hasten  along  the  conservative  action  of  empty- 
ing out  the  intestinal  canal,  is  often  of  great  service. 

Stoppings  Evacuations. — After  tliis  is  accomplished,  however,  each  ad- 
ditional evacuation  is  an  evil,  which  should  be  prevented  by  the  use  of 
five  grains  of  bismuth  or  chalk,  with  three  grains  of  tannic  acid,  or  In  a 
teaspoonful  of  either  syrup  of  galls,  or  syrup  of  krameria,  and  a  quarter 
of  a  grain  of  opium,  or  by  opiates  ci)nd)incd  with  carminatives  like  laven- 


582  DISEASES   OF   THE  DIGESTIVE   SYSTEM. 

der,  or  ginger,  and  camplior,  a  good  mixture  being  ten  drops  of  laudanum, 
fifteen  of  compound  spirits  of  lavender,  and  five  of  spirits  of  camplior, 
taken  on  a  lump  of  sugar  every  Lour  or  two  until  relieved. 

Additional  Treatment. — If  the  stomach  is  unsettled,  as  is  frequently 
the  case,  the  opiate  and  astringent  may  be  administered  with  advantage  by 
enema  or  suppository,  and  in  patients  who  cannot,  or  think  they  cannot, 
retain  medicines  in  either  the  stomach  or  rectum,  hypodermic  injections 
of  the  eighth  of  a  grain  of  morphia  may  often  be  resorted  to  with  the 
happiest  effect. 

Diarrhoea  Mixture — A  good  rule  in  taking  a  diarrhoea  mixture  is  to 
use  a  moderate  dose  evefy  two  hours,  provided  the  loose  passages  recur 
within  that  time,  but  if  at  the  end  of  two  hours  there  has  been  no  liquid 
or  semi-liquid  evacuation  in  the  interval,  to  wait  until  such  a  one  occurs 
before  resorting  again  to  the  remedy.  In  this  way  the  blunder  of  so  over- 
doing the  good  work  of  checking  the  diarrhoea  as  to  inflict  upon  the  system 
its  opposite  evil  of  constipation  may  generally  be  avoided.  The  patient 
thus  gains  from  the  remedy  all  the  good  with  as  little  of  the  necessary 
evil,  which  lurks  in  the  bottom  of  every  cup  of  blessing,  as  possible,  a 
desideratum  which  should  constantly  and  persistently  be  kept  in  view  in 
every  kind  of  medical  treatment,  as  well  as  all  other  affairs  of  life. 

Other  Remedies — Among  the  various  other  valuable  remedies  often 
Leneficial  in  this  exceedingly  common  disorder,  may  be  mentioned  the 
tincture  of  kino,  catechu  and  logwood,  acetate  of  lead,  sulphate  of  copper 
and  suljjhate  of  zinc,  nitrate  of  silver,  spirits  of  chloroform,  tincture  of 
capsicum,  spirits  of  camphor,  compound  spirits  of  lavender,  and  so  forth. 

Accessory  Treatment — In  cases  of  diarrhoea,  where  the  tongue  is 
Avhite  and  coated,  the  pulse  accelerated,  the  temperature  a  little  raised, 
and  some  pain  or  soreness,  increased  by  pressure,  is  felt  in  the  abdomen, 
small  doses  of  epsom  or  Glauber's  salts,  in  conjunction  with  hyoscyamus 
and  opium,  and  perfect  rest  in  bed  with  the  most  rigid  attention  to  diet, 
are  necessary,  lest  the  slight  irritation  of  the  mucous  lining  of  the  ali- 
mentary canal  become  aggravated  into  actual  inflammation,  and  more 
serious  disease,  such  as  dysentery,  enteritis  or  obstinate  chronic  diarrhoea 
result 

Diet. — The  diet  of  a  person  suffering  from  diarrhoea  must  be  very 
strictly  regulated,  and,  in  fact,  nothing  but  tapioca,  sago,  boiled  rice  or 
milk-toast  with  boiled  milk,  twice-boiled  water,  Ix'ef-tea  and  table-tea. 
should,  as  a  rule,  be  put  into  the  stomach.  Even  after  the  malady  seems 
to  be  cured,  much  caution  must  be  exercised  about  returning  to  the  or- 


OONSTIPATIOH.  B83 

dinarj  diet.  This  disease,  like  most  others,  indeed,  exhibits  as  it  passes 
awaj  a  singular  analogy  to  a  conilagration,  which  for  days  after  it  has 
apparently  bcsn  extinguished  is  ready  to  break  out  again,  if  the  remain- 
ing sparks  happen  to  be  fanned  into  a  flame  by  the  wind  or  any  new  fuel 
is  supplied. 

CONSTIPATION  OR  COSTIVENESS. 

Definition. — This  diseased  condition,  the  direct  opposite  of  the  preced- 
ing one,  may  be  defined  as  a  retention  of  the  fecal  matters  beyond  the 
usual  period,  so  that  the}'  are  passed  with  difficulty  and  in  a  comparatively 
hardened  state. 

Causes. — The  causes  of  constipation  are  almost  infinitely  various. 
Every  form  of  impaired  digestion  may  originate  it ;  the  existence  of  piles 
or  hemorrhoids,  a  sedentary  life,  application  to  study,  amenorrhea  and 
uterine  disease  in  females,  all  are  apt  to  induce  it,  and  almost  every  acute 
disease  is  frequently  ushered  in  by  constipation.  It  is  more  often  met 
with  among  women  than  men,  probably  because  the  female  sex  fail  to 
exercise  sufficiently  In  the  open  air ;  and  many  articles  of  food  lai'gely  con- 
tribute to  establish  the  evil  of  habitual  constipation. 

Treatment  of  the  Acute  Form. — If  the  trouble  be  occasional  and  acci- 
dental, any  of  the  milder  laxatives,  such  as  a  tablespoonful  of  epsom  or 
Glauber's  salts,  rochelle  salts,  castor-oil — which  Is  the  safest  purgative,  as 
a  rule — ten  or  fifteen  grains  of  rhubarb,  senna,  or  the  various  purgative 
mineral  waters  may  be  employed.  For  some  patients,  injections  of  warm 
water,  or  soap  and  water,  answer  a  very  good  purpose,  and  if  administered 
with  care  are  iierfcctly  harmless. 

Treatment  of  the  Habitual  Form — Habitual  constipation  is  best 
treated  by  tlie  regulation  of  the  diet,  partaking  of  fresh  or  stewed  fruits, 
bran  bread  and  vegetables  In  season,  in  ^jroportions  sufficient  to  antagonize 
the  torpor  of  the  bowels ;  at  the  same  time  resorting  to  active  exercise  in 
tlie  open  air,  and  endeavoring  to  correct  any  faulty  habit  of  life,  which 
may  be  the  primary  cause  of  the  trouble.  If  the  difficulty  had  its  origin 
in  hereditary  tendency,  or  other  deep-seated  modification  of  the  organism, 
laxatives  should  be  resorted  to,  because,  in  the  writer's  opinion,  at  least, 
the  evils  of  constipation  are  far  greater  than  those  arising  from  the  con- 
stant employment  of  these  medicines. 

Additional  Treatment. — It  Is  probable  that  for  most  persons  saline 
laxatives,  such  as  rochelle  salts,  or  jmrgatlve  waters  during  the  sumTner, 
and  m  cold  weather  pills  of  a  grain  of  rhubarb,  one-sixth  of  a  grain  of 


584"  DISEASES   OF   TUB  DIGESTIVE  SUsTEMo 

poflophyllin  and  a  grain  of  coniponnd  extract  of  colocyntli,  tcaspoonful 
doses  of  the  eomponnd  liquorice  powder,  or  fid.  extract  of  cascara  sagrada 
daily  will  be  beneficial.  This  acts  as  a  tonic  to  the  uuiscular  coat  of  the 
bowels. 

Relieving  Constipation — ^Obstinate  constipation — that  is,  absence  of 
evacuation  for  several  days,  or  a  week  or  two — is  a  dangerous  condition, 
and  should  never  be  permitted  to  occur,  since  the  large  and  densely-packed 
masses  of  feces  may  require  the  operation  of  drastic  cathartics  to  dislodge 
them,  and  such  medicines,  in  accomplishing  their  Avork,  sometimes  set  up 
serious  or  fatal  inflammation.  Liberal  potations  of  castor-oil,  aided  by 
large  enemas,  may  first  be  tried  in  such  u  cas: ;  then  senna,  in  tcaspoonful 
doses  of  the  fliiid  extract ;  then  quarter  or  half-grain  doses  of  tartar  emetic, 
in  conjunction  with  epsom  salts,  and  if  these  fail,  it  may  be  necessary, 
under  skillful  advice  of  a  physician,  to  resort  to  drastic  cathartics,  such  as 
gamboge,  calomel,  elaterium  and  croton  oil,  provided  no  organic  obstruc- 
tion exists. 

HERNIA  OR  RUPTURE. 

Definition. — Ilernia  is  the  name  usually  applied  to  the  protrusion  of 
some  portion  of  the  bowel  or  any  abdominal  viscera  through  the  wall  of 
the  abdomen. 

Varieties. — We  may  have  umbilical  hernia  or  protrusion  of  the  bowel 
at  the  navel,  a  form  often  seen  in  children ;  and  hernia  in  the  gi-oin  or  in- 
guinal hernia,  which  is  probably  a  most  common  variety.  It  has  been 
estimated  that  about  one  man  in  every  seven  is  affected  with  hernia,  but 
in  most  cases  the  intestine  is  kept  in  its  jdace  more  or  less  perfectly  by 
some  form  of  tru  s  When  a  hernia  can  be  pushed  back  it  is  callcii  re- 
ducible. An  irreducible  hernia  cannot  be  returned  into  the  cavity  of  the 
abdomen,  and  is  constantly  in  danger  of  being  inflamed,  by  some  ac- 
cidental blow  for  instance,  and  so  becoming  strangulated. 

Causes. — Ilernia  is  sometimes  produced  or  driven  out  under  some 
treacherous  truss,  which  should  protect  against  such  an  accident,  by  very 
slight  causes,  all  of  which  shoiild  be  carefully  guarded  against  by  those 
who  have  any  hereditary  tendency  to  this  disease.  It  may  be  forced  out 
by  a  jerk,  such  as  suddenly  pulling  open  a  door  that  sticks,  or  by  a  fall, 
by  an  attempt  to  lift  a  heavy  weight  or  to  raise  a  moderate  one  whilst 
in  a  constrained  position,  or  any  other  act  wdiich  tends  to  bring  a  strain 
upon  tlie  bowels,  making  them  bear  downward.  It  is  also  favored  in  its 
occurrence  by  overeating,   by   excessively   exhausting   exertion,    and    by 


JIEKNIA    OR    EUrTURE.  585 

severe  effort  at  times  when  the  body  is  enfeebled  by  disease.  It  is  more 
common  on  the  right  than  on  the  left  side  of  the  body. 

Symptoms. — The  symptoms  of  strangulated  hernia  are  intense  pain, 
not  only  in  the  neighborhood  of  the  rupture  but  over  the  whole  abdomen 
and  especially  around  the  navel,  obstinate  vomiting,  and  cessation  of  the 
passages  from  the  bowels.  At  first  there  may  be  one  or  two  evacuations 
of  the  fecal  matters  already  below  the  seat  of  strangulation,  but  after  that 
is  cleared  out  the  bowels  cease  to  move,  and  if  the  strangulation  is  unre- 
lieved the  vomiting,  which  persists  in  spite  of  all  remedies,  results  in 
bringing  up  fecal  material  through  the  throat.  This  is  a  very  curious 
phenomenon,  and  seems  to  indicate  that  nature  in  her  stupid  zeal  to  get 
rid  of  digested  materials,  on  finding  that  the  usual  avenue  downward  is 
blocked,  soon  reverses  the  normal  peristaltic  movement  and  tries  to  evac- 
uate the  bowels  through  the  mouth.  In  accordance  with  this  idea  the  im- 
portance of  such  stercoraceous  vomiting,  as  it  is  called,  in  the  diagnosis 
of  strangulation  of  a  hernia,  or  some  similar  obstruction,  is  very  great. 

Treatment  of  Strangulated  Hernia. — When  fecal  vomiting  occurs,  if 
undecided  before,  not  a  moment  should  be  lost  in  sending  for  the  best 
medical  skill  which  can  be  procured,  and  which  even  then  may  arrive  too 
late.  In  the  absence  of  medical  assistance,  reduction  of  an  obstinate 
hernia  on  the  point  of  becoming  strangulated,  or  perhaps  already  com- 
pressed, may  sometimes  be  accomplished  by  putting  the  patient  in  a  warm 
bath,  and  so  relaxing  the  system  as  already  explained;  or  a  full  dose  of 
opium  or  morphia,  the  former  preferably  by  enema,  may  perhaps  have  the 
desired  effect;  or  lastly,  the  administration  of  ether  or  chloroform,  by  one 
who  is  accustomed  to  giving  these  anesthetics,  by  still  more  fully  relaxing 
the  system,  may  happily  allow  the  endangered  fold  of  the  intestine  to  be 
pushed  back  into  its  proper  place.  If  the  hernia  cannot  be  reduced  an 
operation  is  absolutely  necessary  and  is  attended  with  but  very  little  risk 
in  the  hands  of  a  skilled  surgeon. 

Treatment  of  Reducible  Hernia. — In  this  form  of  hernia  the  contents 
of  the  sac  can  be  reduced  into  the  abdominal  cavity.  The  treatment  may 
be  palliative  or  radical. 

Palliative  Treatment. — Prevent  constipation,  avoid  sudden  strains 
and  violent  exercise  and  order  a  truss.  The  continual  employment  of  a 
truss,  especially  in  young  persons,  may  bring  about  a  cure.  The  day  truss 
should  be  applied  before  rising  in  the  morning  and  be  removed  after  lying 
down  at  night,  when  a  light  truss  may  be  substituted.  A  truss  is  always 
uncomfortable  at  first,  but  a  person  soon  grows  used  to  it.     It  should  be 


586  DISEASES    OF    THE    DIGESTIVE    SYSTEM. 

kept  i^erfeetly  clean,  and  it  is  well  to  dust  berated  talc  powder  upon  the 
skin  under  the  pad  at  least  once  a  day.  A  truss  which  does  not  keep  the 
hernia  up  increases  pain  and  does  harm.  Too  strong  a  spring  tends  to 
enlarge  the  hernial  opening  and  thus  aggravates  the  cause. 

Radical  Treatment. — This  is  operative  and  the  sac  is  completely  closed 
and  a  new  canal  formed.  These  operations  show  a  very  small  percentage 
of  recurrences. 

INTESTINAL  WORMS. 

The  intestinal  canal  is  often  the  home  of  parasites,  commonly  called 
worms,  and  in  many  parts  of  the  country  nearly  all  children  between  the 
ages  of  one  and  seven  years,  as  well  as  many  older  persons,  are  troubled 
with  these  pests. 

Varieties — 1.  In  childhood  the  usual  inhabitant  of  the  bowels  is  the 
round-worm  or  ascaris  lumbricoides,  a  creature  attaining  the  size  of  a 
large  earth-worm,  which  it  resembles  in  appearance,  except  that  it  is 
whitish  or  brownish,  and  stifFer  and  harder  in  its  structure. 

2.  Children  are  also  often  infested  with  the  oxyuris,  commonly  called 
the  thread-worm,  pin-worm,  or  scat-worm.  This  parasite  is  sometimes 
found  in  great  numbers  about  and  just  within  the  fundament.  In  size 
they  are  very  nearly  that  of  a  very  small  pin  or  piece  of  thread  about  half 
an  inch  long,  but  by  tlicir  number  and  activity  they  often  contrive  to  prove 
very  troublesome  guests  to  their  unwilling  host. 

3.  The  third  common  parasite  which  preys  upon  the  human  species 
is  the  ta?nia  solium  or  tape-worm,  of  which  some  account  has  already  been 
given.  These  parasites  are  always  introduced  into  the  system  from  out- 
side, cither  with  food  or  drink,  and  hence  one  great  reason  for  the  good 
cooking  so  strenuously  urged  in  a  former  chapter.  They  are  a  great  source 
of  irritation  as  long  as  they  remain,  and  in  childhood,  by  the  reflex  irri- 
tation their  movements  in  the  intestines  are  capable  of  exciting,  constitute 
one  of  the  common  causes  of  convulsions.  Exactly  what  articles  of  food 
convey  the  eggs  of  the  round-worms  and  the  pin-worms  into  the  human 
system  has  not  yet  been  discovered,  but  the  tape-worm  is  known  to  iind 
its  entrance  into  our  bodies  Vy  the  eating  of  raw  meat,  generally  beef 
or  pork. 

Symptoms  of  Round-Worms. — The  symptoms  are  often  absent.  "When 
present  there  are  usually  symptoms  of  dyspepsia,  diarrhoea,  with  mucous 
stools,  colicky  pains  in  abdomen,  voracious  appetite  which  it  is  almost 
impossible  to  satisfy.     There  is  anemia  and  often  reflex  nervous  pbenom^ 


COLIC.  587 

•pa  such  as  "night  terrors,"  grinding  of  the  teeth,  itching  of  the  nose  and 
anus,  twitching  of  the  face  and  limbs  and  there  may  be  convulsions. 

Treatment — The  diet  should  he  restricted  before  the  remedy  is  ad- 
ministered. The  most  effective  remedy  is  santonin,  which  is  best  given 
with  calomel,  as  in  the  following: 

R. — Santonin    5  grains 

Calomel    5  grains 

Sugar     20  grains 

Divide   into   ten  powders,   and  take  one   powder  morn- 
ing and  evening. 

Fluid  extract  of  spigelia,  one  to  three  fluid  drachms,  often  proves 
very  effective. 

Symptoms  of  Pin-Worms — These  chiefly  affect  the  lower  colon  and 
rectum,  and  produce  severe  itching  of  the  anus  and  adjacent  parts. 

Treatment — Flush  out  the  bowel  with  water,  then  inject  infusion  of 
quassia  chips  two  or  three  drachms  to  the  pint  of  water. 

Symptoms  of  Tape-Worm — These  are  frequently  absent.  There  may 
be  dyspeptic  symptoms,  colicky  pains  in  abdomen,  loss  of  flesh,  capricious 
appetite  and  at  times  reflex  nervous  phenomena  as  vertigo,  ])alj5itation, 
"night  terrors,"  convulsions,  itching  at  nose  and  twitchings  of  limbs  and 
face,  especially  the  latter. 

Treatment — A  light  diet  for  a  day  or  two  previous  to  the  administra- 
tion of  the  remedy,  so  that  the  worms  will  be  himgry  enough  to  feed 
upon  the  drugs  administered.  After  an  unsubstantial  breakfast  admin- 
ister one  of  the  following  efficient  remedies :  Pumpkin  seeds,  two  to  three 
ounces,  oleoresin  of  aspidium,  one  to  two  drachms ;  pomegranate,  one 
drachm. 

Auxiliary  Treatment — Before  giving  any  of  these  the  bow-els  shoidd 
be  thoroughly  emptied  by  a  good  purge,  and  about  twelve  hours  after  the 
administration  of  the  remedy  another  Jiurge,  preferably  castor  oil, 
should  be  given.  The  treatment  is  successful  only  when  the  head  is  passed, 
so  the  stools  must  be  watched  carefully.  If  not  successful  the  first  time 
try  again  in  a  day  or  two. 

COLIC. 

Colic  is  an  acute  spasmodic  affection  of  the  bowels  without  diarrhcea 
or  much  fever,  but  attended  with  severe  cramps  of  the  abdominal  muscles. 

Causes — Its  most  common  causes  are  indigestible  food,  reflex  irrita- 
tion from  the  uterine  or  ovarian  disease,  and  lead  poisoning. 


588  DISEASES   OF   THE   DIGESTIVE  SYSTEM. 

Symptoms. — Tlie  great  characteristics  of  colic  are  the  griping,  twisting 
pains,  radiating  from  the  navel  and  relieved  by  pressure.  Care  must  be 
taken  not  to  mistake  these  pains  for  those  of  strangulated  hernia,  or  the 
converse,  which  \vt)uld  be  a  much  more  serious  blunder. 

Treatment — The  treatment  is  to  relax  the  spasm  by  opiates,  and 
remove  the  offending  material  if  there  is  any  in  the  bowels.  Tor  the 
former  purpose  twenty  or  thirty  drops  of  laudanum  by  enema  or  hypo- 
dermics of  one-eighth  of  a  grain  of  morphia,  and  for  the  latter  a  table- 
spoonful  of  castor  oil  or  a  Seidlitz  powder  answer  very  well  in  most 
instances. 

HEMORRHOIDS  OR  PILES. 

Hemorrhoids  or  piles  are  exceedingly  common  and  troublesome  com- 
plaints, consisting  of  little  tumors  which  form  at  the  edge  or  just  inside 
the  fundament,  and  give  rise  to  intense  suffering,  especially  when  the 
bowels  are  evacuated. 

Varieties. — There  are  three  varieties :  external,  internal  and  mixed. 

Causes. — Their  production  is  favored  by  constipation,  sedentary 
habits,  hard  seats,  and  some  forms  of  liver  complaint. 

Symptoms — The  inflammatory  enlargement  is  detected  and  is  tender 
and  inriamed.  Pain  on  evacuation  of  bowels.  The  external  variety  does 
not  bleed.  Very  often  their  surface,  which  in  the  internal  variety  is  com- 
posed of  the  distended  mucous  membrane,  exudes  blood,  in  which  case 
they  are  called  bleeding  piles.  When  seated  outside  the  margin  of  the 
fundament  tliey  are  not  so  apt  to  bleed,  and  receive  the  name  of  blind  piles. 

Treatment. — They  niay  generally  be  prevented  from  developing  by 
proper  attention  to  the  bowels,  non-stimulating  diet  and  rest,  and,  whilst 
small,  an  ointment  of  ten  grains  of  extract  of  belladonna,  thirty  grains  of 
tannin,  and  twenty  grains  of  powdered  opium  in  an  ounce  of  simple  oint- 
ment, will  usually  relieve  them. 

Auxiliary  Treatment — Injections  of  cold  water  into  the  rectum,  bath- 
ing the  parts  with  cold  water  after  each  bowel  movement,  or  an  ointment  of 

riirysarohin   IS  grains 

Iodoform    5  grains 

Extract  belladonna   lo  grains 

Vaseline    4  drachms 

Apply  tlircc  times  a  day. 

Apply  this  night  and  morning  after  carefully  cleansing  the  part.  Ex- 
tract of  homamelis  is  a  valuable  application  for  external  piles,    When  the 


FIST0LA  IN   ANO.  589 

acute  symptoms  subside  use  lead  water  and  laudanum.  If  the  internal 
piles  prolapse  and  inflame  use,  in  addition  to  the  above,  Allinghour's  oint- 
ment on  the  parts.  If  the  piles  are  protinidiug  and  reduction  cannot  he 
affected  put  the  patient  to  hed,  give  a  hypodermic  of  morphine  sulphate 
one-fourth  grain  and  apply  hot  poultices. 

Surgical  Treatment — If  hemorrhoids  do  not  yield  to  the  above  treat- 
ment surgical  operation  is  necessary,  which  is  accompanied  with  very 
little  danger.  It  may  be  done  under  local  anesthesia,  but  general  anes- 
thesia enables  an  operator  to  accomplish  his  task  with  more  thoroughness. 

FISTULA  IN  ANO. 

Causes. — Fistula  in  auo  is  a  very  painful  disease,  in  which  a  com- 
munication at  the  side  of  the  fundament  is  opened  through  the  flesh  into 
the  rectum,  or  lower  bowel,  above  the  sphincter  or  muscle  which  ordinarily 
keeps  it  closed.  It  is  usually  the  result  of  an  abscess  at  the  side  of  the 
intestine.  There  are  several  varieties  of  fistula,  in  the  worst  of  which  the 
fecal  matters  from  the  intestines  constantly  leak  out  through  the  hole 
or  sinus,  and  besides  causing  great  irritation  and  pain,  render  the  sufferer 
disgusting  to  every  one  whom  he  approaches.  Most  of  these  different 
forms  of  fistula  can,  however,  be  cured  by  severe  surgical  operations. 

Fissure  of  the  Anus. — This  is  another  painful  affection,  in  which  a 
slit  or  crack  appears  in  the  side  of  the  fundament,  often  the  result  of  a 
small  ulcer  at  the  edge  of  the  opening.  As  it  must  be  torn  apart  eveiy 
time  the  bowels  move  it  is  very  difficult  to  heal.  Sometimes  fissures  of  this 
kind  can  be  cured  by  touching  the  sore  with  caustic,  and  using  laudanum 
injections  to  keep  the  intestine  in  a  state  of  comparative  rest,  but  if  these 
fail  a  surgical  operation  is  the  only  remedy. 

Prolapsus  Ani,  called  also  falling  of  the  bowel,  is  the  coming  down 
of  the  rectum,  which  protrudes  outside  of  the  body  sometimes  to  the  dis- 
tance of  three  or  four  inches.  It  generally  results  from  constipation,  and 
is  especially  apt  to  occur  in  weakly  and  neglected  children.  The  protrud- 
ing portion  of  the  intestine  should  be  carefully  aild  gently  pushed  back  to 
its  place  with  the  fingers  covered  with  a  well-oiled  silk  handkerchief,  and 
suitable  apparatus  obtained  from  the  instrument  makers  to  keep  it  in 
position.     Sometimes  an  operation  is  necessary. 


690  DISEASES  OF  THE  DIGESTIVE  SYSTEM. 

DISEASES  OF  THE  LIVER 

JAUNDICE. 

Jaundice  is  rather  a  symptom  of  disease  than  a  separate  mahidy. 

Causes. — It  may  be  due  to  a  suppression  of  the  secretion  of  bile  by  the 
hepatic  cells;  or,  again,  by  an  over-activity  of  these  elements,  and  a  super- 
abundant supply  of  bile  in  the  system;  or,  thirdly,  by  obstruction  to  the 
outflow  of  bile,  and  reabsorption  of  its  elements  into  the  blood. 

Symptoms. — It  consists  of  a  morbid  yellowness  of  the  skin,  the  white 
of  the  eye  and  other  parts ;  but  in  bad  cases  this  yellowness  may  become  so 
intense  as  to  appear  olive-green,  brown  or  even  black.  The  i;rine  is  also 
of  a  _yellow  or  saffron  color,  but  the  discharges  from  the  bowels  are  pale 
and  devoid  of  the  natural  brownish-yellow  tint,  sometimes  having  the 
bluish-white  of  potter's  clay.  Troublesome  itching  of  the  skin,  slow  pulse, 
low  temperatures,  debility  and  a  tendency  to  hemorrhage  from  the  mncous 
membranes  are  frequent  in  jaundice. 

Diagnosis. — The  most  important  practical  point  is  to  detennine 
whether  the  gall-ducts  are  obstructed  or  not.  If  they  are  closed,  so  that 
the  stools  contain  no  bile,  the  jaundice  speedily  becomes  intense  and  the 
swollen  gall-bladder  can  sometimes  be  felt  below  the  edge  of  the  ribs. 
When  not  obstructed,  the  reverse  is  the  case.  Jaimdice  which  comes  on 
suddenly  is  probably  due  either  to  a  gall-stone  or  to  nervous  disturbance. 
Intense  jaundice  which  has  developed  very  gradually  probably  results 
from  pressure  outside  of  the  gall-duct,  such  as  would  be  produced  by  a 
tTunor  or  cancer. 

Gall-Stones. — Intermittent  attacks  of  jaundice  point  to  gall-stones  in 
old  people,  and  to  catarrh  of  the  bile-ducts  in  children.  Paroxj'smal  pain 
preceding  jaundice  points  to  gall-stones;  following  jaundice,  to  cancer 
of  the  liver.  Jaiindice  with  great  enlargement  of  the  liver,  if  the  latter 
is  painful  and  tender  on  pressure,  indicates  cancer;  if  painless,  it  sug- 
gests the  waxy  or  lardaceoias  condition  of  the  liver.  When  jaundice  ac- 
companies ascites,  it  is  ustially  due  either  to  cancer  or  cirrhosis.  The 
danger  of  life  from  jaundice,  unless  it  does  indicate  some  fatal  disease 
like  cancer  or  cirrhosis,  is  small ;  but  in  its  severer  forms  it  is  often  very 
obstinate,  lasting  for  weeks  or  months. 

Treatment. — The  treatment  consists  of  small  doses  of  calomel  or  blue 


LIVER     COMPLAINT. 


Normal  or  healthy  liver 


Diseased  liver 


KIDNEY     DISEASE. 


Healthy  kidney 


Bright's  disease 


COFTfllCHT    ISiS    BYE,  J   STANlCf 


ABSCESS  OF  THE  LIVEB.  591 

pill  followed  by  a  saline  purge  for  a  few  days,  avoiding  salivation.  The 
mercurial  medicine  may  be  substituted  or  aided  by  five  grains  of  extract 
of  taraxacum;  podophyllin  and  leptandrin,  in  quarter-grain  doses,  and 
bicarbonate  of  soda  in  quantities  of  ten  grains.  Later  on  in  tbe  attack, 
five-drop  doses  of  diluted  nitro-muriatic  acid  may  be  administered  with 
advantage,  leaving  a  few  days'  interval  between  the  last  dose  of  any 
mercurial  and  the  acid  remedy.     The  phosphate  of  soda  is  also  useful. 

Jaimdice  of  Infancy — It  is  very  common  to  observe  jaundice  com- 
mence in  the  first  or  second  day  after  birth.  Usually  of  no  importance. 
Probably  due  to  diminished  pressure  in  the  portal  system  or  to  potent 
ductus  arteriosus.  Recovery  takes  place  in  a  few  days  or  weeks.  The 
severe  forms  may  depend  on  septic  poisoning  with  inflammation  of  the 
umbilical  vein,  congenital  inflammation  of  the  liver  due  to  syphilis  or 
congenital  absence  of  the  hepatic  duct. 

CONGESTION  OF  THE  IIVER. 

Causes.— Acute  congestion  of  the  liver  may  result  from  cold,  from 
over-eating,  or  from  the  abuse  of  alcohol. 

Symptoms — Its  symptoms  are  enlargement  of  the  organ  with  tender- 
ness on  pressure,  and  a  feeling  of  painful  tension  on  the  right  side  just 
above  the  edge  of  the  ribs,  often  radiating  to  the  right  shoulder,  slight 
jaundice,  furred  tongue,  loss  of  appetite  and  scanty,  high-colored  urine 
are  present,  and  the  whole  group  of  symptoms  constitues  the  condition 
commonly  designated  as  "being  bilious." 

Treatment. — ^It  is  generally  relieved  by  a  small  blue  pill,  or  small 
doses  of  calomel  followed  by  a  saline  purgative,  and  attention  to  diet  for  a 
few  days.  If  neglected  this  form  may  run  on  to  chronic  congestion  or  lay 
the  foundation  of  inflammation  of  the  liver. 

ABSCESS  OF  THE  LIVER. 

Abscess  of  the  liver  is  the  formation  of  pus  in  the  substance  of  the 
organ.     There  may  be  one  large  abscess  cavity  or  many  small  ones. 
Causes — 1.  It  may  be  due  to  injury. 

2.  The  presence  in  the  liver  of  the  amvela  culi  of  dysentery. 

3.  Foreign  bodies,  gall-stones  and  retained  bile. 

4.  Septic  emboli  which  may  come  through  the  hepatic  artery  but 
usually  through  the  portal  vein  from  other  diseased  viscera  and  produce 
a  purulent  inflammation  of  the  vein. 


593  DISEASES   OF   THE  DIOESTIVE  SYSTEM. 

Sjnnptoms. — The  fever  is  of  the  hectic  variety,  high  in  the  evening 
and  low  ill  the  morning.  Chills  are  sometimes  present;  pain  is  variable 
and  may  be  felt  in  back  of  right  shoulder.  The  liver  is  enlarged,  painful 
and  tender,  ^Marked  jaundice  is  rare.  There  may  be  bulging,  and  fluctu- 
ation is  sometimes  detected. 

Treatment. — There  is  only  one  treatment,  whicli  is  surgical. 

Degenerations  of  the  Liver.- — Acute  atrophy  of  the  liver,  waxy  liver, 
and  fibroid  deposit  in  the  liver  are  various  forms  of  degeneration  for 
which  little  can  be  done  by  medical  treatment  and  which  are  fortunately 
rare.  Not  so,  however,  as  far  as  regards  infrequency,  with  cirrhosis  of 
the  liver,  called  also  drunkard's  liver  and  hob-nail  liver,  because  of  its 
origin  in  the  abuse  of  alcohol  and  the  peculiar  contracted  form  which  it 
presents.  The  process  which  the  liver  undergoes  is  a  condensation  of  the 
substance  and  destruction  of  the  secreting  cells,  with  thickening  of  the 
connective  tissue.  The  whole  liver  gi-adnally  contracts,  ceases  in  great 
measure  to  manufacture  bile  and,  becoming  an  obstruction  to  the  venous 
circulation,  produces  ascites  or  abdominal  dropsy,  under  which  the  suf- 
ferer generally  succumbs. 

LIVER  OR  HEPATIC  COLIC  (GALL-STONES). 

Gall-stones  are  hard  concretions  whicli  form  within  the  gall-bladder, 
and  when  they  attempt  to  pass  out  through  the  gall-duct  often  give  rise 
to  the  most  excruciating  agony  which  the  human  being  is  capable  of 
suffering. 

Symptoms. — This  pain  is  called  hepatic  colic,  on  account  of  its  grip- 
ing, tearing  character,  and  may  generally  be  distinguished  by  its  coming 
on  and  passing  off  suddenly;  by  its  frightful  intensity;  by  being  deep- 
seated  instead  of  superficial;  by  being  accompanied  with  vomiting  and  by 
the  pulse  being  rapid  and  feeble.  The  onset  may  be  marked  by  a  chill  and 
fever.  It  may  last  from  a  few  moments  to  several  days,  and  is  often  so 
severe  that  strong  men  will  sometimes  writhe  and  roll  around  on  the 
floor,  screaming  in  their  agony.  It  seldom  comes  on  before  middle  life, 
and  women  are  much  more  frequently  attacked  than  men.  The  pain  is 
chiefly  in  the  upper  part  of  the  abdomen  on  the  right  side.  If  a  gall-stone 
remains  in  the  duet  for  more  than  twelve  hours,  it  is  usually  followed  by 
jaundice  coming  on  two  or  three  days  later.  The  affection  terminates 
either  by  the  stone  slipping  back  into  the  gall-bladder  or  passing  out 
through  the  duct  into  the  bowel,  in  which  latter  event  it  may  be  found 


DEOPST   OF   THE  ABDOMINAI,    CAVITY.  593 

in  the  evacuations  during  the  next  week,  and  should  always  he  searched 
for.  The  stone  usually  varies  in  size  from  that  of  a  small  shot  to  an  inch 
or  more  in  diameter,  and  in  color  from  yellowish-white  to  dark-brown.  If 
single,  it  is  usually  oval  or  rounded  ;  but  if  two  or  more  have  been  formed, 
the  first  one  is  marked  by  impressions  of  the  others,  and  thus  the  prospect 
of  future  attacks  can  be  estimated.  Notwithstanding  the  alarming  suffer- 
ing the  danger  to  life  is  small,  and  death  rarely  eventuates  from  hepatic 
colic. 

Treatment — The  treatment  is  by  thirty-drop  laudanum  enemas  or 
hypodermic  injections  of  a  quarter  of  a  grain  of  morphia  and  one-one- 
hundredth  of  a  grain  of  atropia,  with  chloroform  or  ether  by  inhalation,  if 
the  pain  is  unendurable.  Hot  fomentations,  or  hot  baths,  sometimes 
afford  partial  relief.  In  order  to  prevent  the  recurrence  of  hepatic  colic, 
small  doses  of  carbonate  of  soda,  alkaline  mineral  waters,  or  a  mixture 
of  chloroform  and  turpentine  have  been  higlily  reconiniended. 

Value  of  X-Ray — The  use  of  the  X-ray  was  found  valuable  in  the 
diagnosis  of  gall-stones. 

ASCITES  OR  DROPSY  OF  THE  ABDOMINAL  CAVITY. 

Symptoms. — The  prominent  symptom  of  ascites  is  the  distension  of 
the  abaomen,  which  sometimes  becomes  enormously  swollen,  and  by  the 
pressure  upward  of  the  diaphragm  gives  rise  to  distressing  dyspnoea. 

Treatment. — When  possible  endeavor  to  i-emove  the  cause.  Purge 
freely  with  concentrated  salines,  compound  jalap  powder  twenty  to  tliirtv 
grains,  elaterium  one-eighth  grain.  Increase  the  action  of  the  kidneys  by 
infusion  of  digitalis  two  drachms,  citrate  of  caffeine  three  to  five  grains, 
diuretin  fifteen  to  thirty  grains. 

Atixiliary  Treatment — If  the  effusion  is  large  and  does  not  yield  to 
the  above  treatment  tapping  is  indicated,  which  is  a  procedure  accom- 
panied by  very  little  danger.  No  anesthetic  is  required,  and  it  gives 
almost  immediate  relief  to  the  dyspnoea.  Care  must  be  taken  not  to 
draw  off  the  fluid  too  rapidly,  as  this  might  cause  collapse. 


38 


394  DISEASES   OF    TIIK   DIQKSTIVJ;   SYSTEM. 

LIVER  COMPLAINT. 

Causes. — A  congoPtcd  .state  of  tlio  liver  which  may  depend  on  an 
obstruction  in  the  portal  and  hepatic  Yenous  system,  in  which  there  is  a 
deficiency  of  tone  in  the  veins  which  prevents  the  normal  ascent  of  the 
hlood  from  the  lower  parts  of  the  body,  thereby  distending  the  vessels 
and  causing  an  accumulation  of  blood.  This  inability  of  the  blood  to 
ascend  against  gravity  is  found  in  a  great  variety  of  chronic  diseases. 
A  very  frequent  cause  of  disease  of  the  liver  is  the  indulgence  in  alcoholic 
stimulants  and  the  eating  of  too  highly  seasoned  food. 

Symptoms — 1.  Perhaps  there  is  no  disease  in  the  whole  human  frame 
in  which  symptoms  assist  less.  In  some  of  the  more  acute  forms  of  the 
disease  the  sjTnptoms  are  urgent,  but  except  in  a  few  instances  they 
convey  little  or  no  information  with  respect  to  the  nature  or  progress  of 
the  disease,  and  in  the  more  chronic  forms  irreparable  mischief  is  often 
established  before  the  patient  even  suspects  that  there  is  anything  wrong. 
There  are,  however,  certain  general  svmptoms  which,  when  present,  en- 
able us  to  pronounce  pretty  positively  as  to  the  existence  of  liver  disease, 
thoiigh  they  will  not  assist  in  determining  its  nature.  These  are  dropsy, 
indigestion  and  jaundice.  The  tongue  is  generally  coated  and  commonly 
furred.  A  disagreeable,  bitterish  taste  is  felt  in  the  mouth,  and  eructa- 
tions take  place,  sometimes  bitter,  cutting,  acrid  and  even  excoriating 
the  lining  of  the  throat.  The  skin  may  bo  hot  and  dry-parched  and 
rough,  or  it  may  be  too  relaxed,  giving  rise  to  cold,  clammy  sweats. 

2.  There  is  no  excretion,  not  even  excepting  the  bowel  evacuations, 
"which  is  more  frequently  deranged  in  diseases  of  the  liver  than  urine. 
Thus,  bile  may  be  detected  in  the  urine  when  no  other  irregularity  is 
present  by  the  application  of  muriatic  acid. 

3.  Kot  unfrcqucutly  a  jtatient  has  lost  the  power  of  assimilation,  not 
from  any  well  defined  organic  lesion  of  the  liver  or  alimentary  canal, 
biit  rather  because  of  a  stagnation  of  want  of  proper  secretion  through  the 
ducts  of  the  liver.  When  these  become  deficient  in  secretion  the  healthy 
action  of  the  liver  is  arrested  and  various  disorders  immediately  begin  to 
be  manifested.  The  bowels  do  not  move  freely ;  the  bile,  instead  of  getting 
excreted  by  the  intestines,  is  taken  up  by  the  blood.  In  consequence  the 
internal  organs  suffer  end  a  bilious  attack  follows.  After  frequent 
attacks  the  skin  becomes  sallow,  rough  and  yellowish,  and  you  are  affected 
with  headache,  constipated  bowels,  coated  tongue,  pain  in  the  right 
shoulder  and  side  from  the  poison  left  behind  in  the  blood.  Here  is  the 
first  seat-origin  of  pulmonary  consumption. 


LIVEE  COMPLAINT.  595 

4.  The  so-called  biliousness,  indigestion,  capricious  appetite,  pain 
after  food,  eructations,  acidity,  flatulence,  irregularity  in  the  bowels, 
■whether  as  constipation  or  diarrhoea,  point  almost  always  to  this  disturb- 
ance, and  it  is  a  most  potent  factor  in  causing  and  inviting  other  diseases. 

5.  The  modern  liver  is  a  degenerate  organ ;  the  average  digestion  far 
below  the  standard  of  old,  and  its  function  abnormally  feeble  and  slow. 
Gout  and  uric  acid  congeries  prevail  to  a  remarkable  extent,  and  the 
ailments,  directly  or  indirectly  attribiitable  to  malnutrition,  meet  the 
busy  practitioner  at  every  turn,  The  bilious  attack  of  olden  time,  for 
which  mercury  was  a  specific,  and  that  of  to-day  are  alike.  The  former 
was  almost  always  the  invariable  penalty  of  a  "surfeit,"  brought  on  by 
inordinate  indulgence  in  the  pleasures  of  the  table,  in  an  age  when  the 
"three-bottle  man"  was  a  hero  of  every  convivial  gathering,  and  the  ap- 
petite on  the  morning  following  a  "night  out"  iisually  unequal  to  the 
most  exacting  demands  of  a  bountifully-spread  board,  without  the  aid  of 
the  seductive  but  dyspepsia-breeding  cocktail.  The  latter-day  biliousness, 
on  the  other  hand,  comes  on  insidiously,  often  without  apparent  cause,  and 
follows  the  most  trifling  indiscretion  in  diet.  The  digestive  organs  being 
weak  to  begin  with,  a  slight  excess  of  intestinal  decomposition  is  easily 
provoked,  and  the  whole  system  becomes  gi'adually  saturated  with  its 
poisonous  products.  This  condition,  therefore,  is  not  amenable  to  the 
mercury  treatment. 

Treatment — 1.  The  successful  treatment  of  the  modern  form  of  the 
disorder  is  but  just  begim  when  all  putrescent  elements  of  ingested  food 
have  been  carried  off  by  purgation.  The  condition  remaining,  in  which 
there  are  large  amounts  of  slowly  accumulated  deposits  in  the  system 
which  the  unaided  efforts  of  nature  are  impotent  to  remove. 

A  pill  composed  of  aloin,  may-aiiple  and  nux  vomica,  an  eighth  of  a 
grain  of  each,  may  be  taken  at  night,  or  night  and  morning,  until  the 
bowels  become  regular.  By  their  judicious  use  the  digestion  will  be  im- 
proved, also  the  general  health,  thereby  avoiding  those  principal  sequences 
which  attend  the  constipated  condition. 

2.  Medicines  should  be  "arms  of  precision."  The  physician  cannot 
push  his  remedies  to  the  limit  of  safety  unless  he  has  perfect  confidence 
in  their  purity  and  accuracy.  This  combination  accomplishes  this  in  a 
threefold  manner.  The  may-apple  increases  the  healthy  action  and 
secretion  in  the  ducts  of  tlie  liver.  The  nux  vomica,  by  its  stimulating 
and  tonic  effect  on  the  stomach,  enables  it  to  better  assimilate  and  digest 
the  food;  while  the  aloin  completely  cleanses  the  walls  of  the  alimentary 
e«nal. 


596  DISEASES  OF  THK  niGF.STIVE  SYSTEM. 

Through  their  combined  action  the  system  is  restored  to  its  normal 
standard.  This  is  the  secret  of  their  curative  power  in  the  treatment  of 
liver  disease.  This  secret  is  one  of  immense  power.  They  not  only 
stimulate  the  brain  by  their  action  in  generating  more  gray  matter,  but 
in  some  mysterious  manner  vivify  the  great  sympathetic  nerve  wliioli 
covers  the  bowels  and  energizes  the  eighth  pair  of  nerves  which  supplies 
the  liver.  They  speedily  affect  the  liver,  restore  the  gland  to  its  jiristinc 
activity,  and  the  bowels  become  regulai*,  the  complexion  clear,  the  breath 
sweet  and  the  whole  body  seems  rejuvenated,  proving  that  the  liver  ha? 
renewed  its  normal  function. 

"When  the  bowels  do  not  move  freely  the  liver  becomes  congested, 
and  the  bile,  instead  of  being  excreted  by  the  intestines,  is  taken  up  by 
the  blood.  In  consequence  the  internal  organs  suffer  and  a  bilious 
attack  follows.  After  frequent  attacks  the  skin  becomes  sallow,  rough 
and  yellowish,  and  you  are  troubled  with  headache,  constipated  bowels, 
coated  tongue,  pains  in  side,  and  your  whole  system  feels  out  of  sorts. 
For  this  condition  take  three  pills  on  retiring  at  night. 

For  an  aggravated  attack  of  biliousness  or  chronic  liver  disease  take 
one  pill  three  times  a  day  for  one  week.  Take  one  pill  each  night  at  bed- 
time for  two  weeks,  after  which  take  one  pill  twice  a  week  for  about 
three  weeks. 

For  a  slight  attack  of  bilioiisness,  indigestion,  and  so  forth,  take  two 
pills  on  retiring  and  one  pill  each  night  afterward  until  five  have  been 
taken. 

Auxiliary  Treatment. — "When  suffering  from  this  disease  the  diet 
should  first  be  considered.  Light  gruel  or  toast  water  and  buttermilk 
or  skimmed  milk  can  be  taken.  Light  mutton  or  chicken  broth,  after 
removing  the  greasy  portion  from  the  top.  Food  should  not  be  eaten 
between  meals,  of  any  kind.  Alcohol  or  malt  liquors,  as  also  tobacco,  are 
to  be  avoided.  For  the  relief  of  pain  in  the  side  over  region  of  liver 
apply  a  hot  hop  poidtice,  or,  what  is  preferable,  a  hot-water  bag  should  bo 
placed  over  this  region  and  replenished  so  as  to  keep  up  constant  heat. 
In  severe  cases  the  tension  may  be  relaxed  by  a  mustard  plaster  or  an 
application  of  spirits  of  turpentine  well  rubbed  in.  This  acts  as  a  counter- 
irritant  and  often  gives  speedy  relief.  If  the  patient  continues  to  vomit, 
a  little  lime-water  and  milk — a  teaspoonful  of  lime-water  in  a  cup  of  milk 
— or  a  mustard  plaster  made  with  the  white  of  egg  and  applied  to  pit  of 
stomach  will  frequently  give  immediate  relief.  Regarding  diet,  it  should 
bland  and  unirritating. 


PART  VIII  OF  BOOK  IV 

Treats  of  the  diseases  to  which  the  Genito-Urinary 
System  is  subject. 


Bladder,   Inflammation  of    607 

Stone  in   608 

Bloody  Urine   603 

Bright's  Disease,  Acute  600 

Causes  of    600 

Symptoms  of    601 

Treatment  of   601 

Urine   in    601 

Bright's  Disease,  Chronic  602 

Causes  of    602 

Symptoms  of   602 

Treatment  of   602 

Calculus    608 

Catheter,  use  of  610 

Chancre    620 

Treatment  of    620 

Chancroid  Sore   618 

Colic,    Renal   or   Nephritic    606 

Cystitis    607 

Chronic    608 

Urine  in  607 

Congenital   Syphilis    620 

Symptoms  of   620 

Diseases  of  the  Urinary  System   599 

Emissions,  Involuntary   626 

Epididymitis    615 

Floating  Kidney    605 

Formin  Compound,  Use  of  in  Gonor- 
rhoea     614 

Gravel    608 

Gonorrhoea    *. 61 1 

Diet  in   613 

Formin  Compound  in   614 

Sanmetto    Treatment     614 

Secondary   Treatment    613 

Symptoms  of    612 

Third    Treatment    613 

Treatment  of   612 

Gonorrheal  Complications   615 

Hematuria    603 

Hysteria,  Suppression  of  Urine  in.. 605 


Inipotency    628 

Inflammation  of  the  Bladder   607 

Involuntary   Emissions    626 

Kidneys,  Function  of   599 

Kidney,  Floating  or   Movable    605 

Movable  Kidney    603 

Nephritis,  Acute   600 

Nephritis,   Chronic   603 

Nephritic   Colic    6o6 

Prostate    Gland 611 

Cure  of    611 

Causes   of    611 

Diseases  of  611 

Pus  in  the  Urine 604 

Pyuria    604 

Renal   Colic    606 

Salvarsan,  Use  of  in  Syphilis  625 

Sanmetto     Treatment     for     Gonor- 
rhoea    614 

Six-O-Six     (606)     Treatment    in    Sy- 
philis    62s 

Sofe-chancre    618 

Spermatorrhoea    626 

Causes   of    627 

Results  of   627 

Treatment  of    627 

Stone  in  the  Bladder  608 

Stricture  of  the  Urethra   609 

Causes   of    609 

Treatment  of  609 

Suppression  of  the  Urine 604 

in  Hysteria   605 

Treatment  of   603 

Swelled   Testicle    613 

Syphilis     617 

Cause   of    617 

Chancroid  Sore   618 

Congenital    620 

Constitutional  Treatment   620 

Conveyed  by  Conception 621 

Eruptions 619 


597 


598 


INDEX  TO  PAKT  VIII  OF  BOOK  IV. 


Syphilis,  Hand  and  Feet   Rniptions.619 

Hereditary    622 

Mercury  Unreliable  in    625 

Salvarsan  Treatment  625 

Secondary     Constitutional     Symp- 
toms     618 

606  Treatment   625 

Sofe-chancre    618 

Symptoms    617 

Tertiary  Symptoms   619 

Tertiary   Treatment   621 

Tonics,  Use  of  621 

Transmission  of    622 

Treatment,  Secondary   620 

Vegetable  Treatment  625 


Syphilitic,  Marriage  of  621 

Tertiary    Syphilis    619 

Treatment  of   621 

Testicle,  Swelled  615 

Tonics,  Use  of,  in  Syphilis   621 

Uremia    603 

Urethra,  Inflammation  of   611 

Stricture  of  ...  609 

Urine,   Bloody    603 

In  Cystitis    607 

Pus   in 604 

Suppression  of    604 

Varicocele    616 

Vegetable  Treatment  in  Syphilis  625 


CURATIVE    MEDICINE 


PART  VIII. 
DISEASES  OF  THE   URINARY  SYSTEM 

The  Urinary  Organs. — The  important  group  of  organs  whicli  makes 
up  this  system  comprises  the  kidneys,  two  glandular  bodies  about  four 
inches  long,  and  of  the  peculiar  sliai)e  of  a  kidney-bean,  with  their  outlet 
pipes  communicating  with  the  bladder,  and  its  exit  tube  the  urethra, 
opening  in  both  sexes  in  conjunction  with  the  organs  of  generation. 

Office  of  the  Kidneys. — The  ofBce  of  the  kidneys  in  the  animal 
economy  is  to  secrete  the  urine  "which  passes  from  each  gland  down  its 
separate  ureter  into  the  bladder,  where  it  may  be  stored  to  the  amount  of 
half  a  pint  or  a  pint,  and  from  which  it  oiight,  at  suitable  intervals  of  from 
four  to  six  hours,  to  be  evacuated.  The  ingredients  of  the  urine  being 
waste  material,  poisonous  to  the  organism  if  retained  in  the  blood,  it  will 
readily  be  understood  why  the  suppression  of  the  renal  secretion,  in 
certain  morbid  conditions,  or  its  retention  in  consequence  of  any  obstruc- 
tion to  its  outflow,  in  the  narrow  ureters  or  urethra,  may  give  rise  to  some 
of  the  most  horribly  painful  and  fatal  diseases  which  mankind  is  ever 
called  upon  to  endure. 

Function  of  the  Kidneys — The  function  of  the  kidneys  is  purely  an 
eliminative  one,  and  a  full  understanding  of  its  performance  could  only 
be  gained  by  a  study  of  the  intricate  structure  of  the  organs,  too  complex 
to  be  considered  here.  It  is  sufficient  for  the  present  purpose  to  state, 
that  the  blood  entering  each  kidney  by  its  largo  renal  artery  is  purified 
by  having  removed  from  it  the  elements  of  a  poisonous  substance,  urea, 
with  uric  or  lithic  acid,  phosphoric  acid,  and  sulphuric  acid,  variously 
combined  with  potash,  soda,  lime,  magnesia,  and  probably  other  refuse 
matters  in  smaller  amounts.  These  solid  ingredients  of  the  urine  are  dis- 
solved in  the  forty  or  fifty  ounces  of  v/ater  which  is  also  during  health 

(599) 


600  DISEASES   OF   THF   UEINARY    SYSTEM. 

talvcn  out  of  the  blood  lij  tho  kidneys,  and  in  this  way  the  urine  is  manu- 
factured. The  purified  blood,  after  giving  up  these  deleterious  matters  in. 
the  renal  organs,  is  returned  to  the  general  circulation  by  the  renal  veins. 

Passage  of  Urine. — In  perfect  health  a  man  of  average  size  would 
pass  iu  the  forty-eight  ounces  of  urine,  which  he  should  daily  evacuate 
from  his  bladder,  an  ounce  and  one-third  of  urea,  nearly  an  ounce  of 
chlorides,  sulphates  and  phosphates,  and  from  eight  to  twelve  grains  of 
uric  acid.  If,  for  any  reason,  the  amount  of  water  filtered  out  of  the 
blood  is  less  than  this,  there  is  danger  that  some  solid  constituents  of  the 
urine  may  crystallize  within  the  urine  or  bladder,  and  being,  perhaps, 
washed  into  the  ureters  in  the  one  case,  or  into  the  urethra  in  the  other, 
block  up  these  outlets  and  give  rise  to  the  horrible  agony  of  nephritio 
colic,  gravel  or  stone  in  the  bladder;  or,  again,  even  slight  inflammation 
iu  these  small  tubes  may  result  in  a  contraction  or  stricture,  which  hinders 
the  passage  of  the  urine,  and  also  causes  great  suffering  to  the  unfortunate 
patient. 

Guide  to  Kidney  Disease — The  chief  guide  to  diseases  of  the  kidneys 
is,  necessarily,  therefore,  a  chemical  and  microscopical  examination  of  the 
urine,  with  the  sediments  which  fall  from  it,  in  each  individual  case,  and 
this  should  never  be  neglected  in  any  but  the  most  temporary  and  in- 
significant derangements  of  the  urinary  apparatus. 

ACITTE  WEPHKITIS  OR  ACUTE  BRIGHT'S  DISEASE. 

Nature  of  the  Disease — Acute  Bright's  disease,  called  also  acute 
nephritis,  is  a  malady  in  which  the  kidney  becomes  greatly  enlarged  and 
vascular,  with  its  minute  convoluted  tubes,  in  which  the  urine  is  primarily 
manufactured,  plugged  up  with  epithelial  cells. '  These  epithelial  cells  in 
the  form  of  casts  of  the  renal  tubules  are  voided  in  the  urine  together 
with  albumen,  and  sometimes  with  blood.  The  obstruction  to  the  outflow 
of  the  urine  and  the  interference  with  the  function  of  the  kidney  give  rise 
to  the  most  serious  general  symptoms. 

Causes. — Acute  Bright's  disease  is  a  rather  common  complication  of 
scarlet  fever,  and  is  one  of  the  dangers  most  to  be  dreaded  in  that  malady. 
It  also  occurs  in  cholera,  yellow  fever,  scarlet  fever,  erysipelas  and  diph- 
theria, and  may  be  produced  by  alcoholic  intemperance,  or  by  exposure 
to  cold  and  wet,  particularly  by  sitting  on  a  wet  or  cold  object,  such  as  a 
stone  step.     Certain  poisons  which  are  eliminated  through  the  kidneys,  as 


COl 

cantharides  and  turpentine.  Pregnancy  is  also  a  potent  factor  in  tho 
cause  of  the  disease. 

Symptoms. — The  symptoms  are,  first,  in  many  cases,  chilliness,  fol- 
lowed by  fever,  some  pain  in  the  loins  and  across  the  lower  part  of  the 
spine,  scanty  high-colored  and  albuminous  urine,  and  in  a  day  or  two 
dropsy,  or  watery  effusion  imder  the  skin,  beginning  beneath  the  lower 
eyelids  or  in  the  organs  of  generation,  but  soon  becoming  general  over 
the  whole  body.    Uremic  coma  may  develop  at  any  time. 

The  Urine. — Scanty  always,  and  at  times  entirely  suppressed.  Smoky 
in  appearance,  high  specific  gravity,  rich  in  albumen  and  throws  down 
a  heavy  sediment,  which,  when  examined  microscopically,  ■will  be  found 
to  contain  hyaline,  blood  and  epithelial  casts,  and  free  blood  and  epithe- 
lium. 

Treatment — The  treatment,  which  is  successful  in  a  majority  of  the 
cases,  consists  in  keeping  the  patient  in  bed  in  a  room  with  a  warm,  moist 
and  equable  temperature,  purging  gently  with  those  laxatives  which 
cause  watery  discharges  from  the  bowels,  such  as  small  doses  of  five 
grains  of  jalap  and  thirty  grains  of  cream  of  tartar,  promoting  free 
perspiration  by  the  use  of  sweat  baths,  which  are  given  by  placing  the 
patient  in  a  tub  of  water  at  the  temperature  of  106  degrees  Fahrenheit 
for  twenty  minutes.  Give  a  thorough  rub  and  place  in  bed  between 
blankets  with  hot  water  bottles,  or  hot  cans  around,  but  not  touching  the 
patient.  A  blanket  shoiild  be  interposed  between  the  skin  and  the  hot 
cans.  Allow  free  perspiration  for  an  hour  to  an  hour  and  a  half.  Sweat- 
ing may  be  aided  by  giving  from  one-twelfth  grain  to  one-eighth  grain  of 
pilocarpine.  Guard  against  collapse  by  giving  strychnine  sulph.,  one- 
twentieth  grain.  Dry  cups  followed  by  hot  fomentations  over  loins.  In 
bad  cases,  with  robust  patients,  cut-cups  or  leeches  may  be  used  in  place  of 
the  dry  cups,  and  acetate  or  citrate  of  potash  in  twenty-grain  doses,  with 
ten  drops  of  tincture  of  digitalis  or  squills,  and  half  a  teaspoonful  of 
sweet  spirits  of  nitre  are  often  given  with  benefit.  Citrate  of  caffeine 
in  one  to  two  grain  doses  may  be  tried.  Infusion  of  digitalis  in  one 
drachm  doses  is  especially  beneficial  in  cliildren.  Diuretin  in  from  ten  to 
twenty  grains  three  times  a  day  for  adults,  and  two  to  five  grains  for 
children  will  often  give  good  results.  Eascham's  mixture,  two  draclims 
thrice  daily.  Niemeyer  recommends  a  pill  if  cedcma  is  present,  composed 
of  blue  mass,  powdered  digitalis,  powdei'ed  squill,  oafh  of  one  grain. 
Take  one  of  these  thrice  daily.  The  following  combination  may  prove 
efficient  in  troublesome  dropsy : 


602  DISEASES   OF   Till'    UltlNAKY   SYSTEM. 

Sparliiir    siilph 4  grains 

Caffeine   citrate    20  grains 

Lithia   bcnzoatc    40  grains 

Divide  into  ten  powders,  and  take  one  every  three  hours. 

CHRONIC  BRIGHT'S  DISEASE  OR  CHRONIC  NEPHRITIS. 

Causes. — It  may  follow  the  acute,  or  may  be  chronic  from  the  be- 
giiiiungj.  Males  are  most  frequently  attacked.  Adult  life,  frequent  ex- 
posure to  ■vvet  and  cold,  alcoholism  and  congestion  from  heart  disease  and 
syphilis  are  the  chief  predisposing  causes. 

Symptoms — The  symptoms  of  well-defined  chronic  Bright's  disease 
are  albuminous  urine,  containing  renal  epithelial  cells  and  tube-casts,  more 
or  less  drojjsical  effusion,  esjJecially  noticeable  about  tlie  face  and  ankles, 
anemia,  shortness  of  breath,  a  peculiar  dryness  of  the  skin,  dyspepsia, 
headache  and  giddiness,  together  with  a  tendency  to  dimness  of  sight  and 
inflammation  of  the  retina  of  the  eye,  uremia  or  blood-poisoning  from  the 
retention  of  the  urea,  which  ought  to  be  removed  by  the  kidneys  in 
the  circulating  fluid,  secondary  inflammations,  such  as  pneumonia  and 
pericarditis  and  hypertrophy  of  the  heart.  Its  presence  can  only  be  posi- 
tively ascertained  by  thorough  microscopical  examination  of  the  urine,  and 
such  examinations  repeated  from  time  to  time  are  the  best  guides  as  to  the 
necessary  treatment.  The  variety  is  essentially  chronic,  running  a  course 
of  months  or  years,  with  a  tendency  to  temporary  improvement  under 
treatment,  on  the  one  hand,  and  to  subacute  exacerbations  in  consequence 
of  unhygienic  imprudences  on  the  other.  It  almost  always  proves  fatal 
in  the  end,  however,  by  uremia  with  or  without  convulsions,  by  secondary 
inflammations,  or  perhaps  by  general  debility.  It  is  estimated  that  uremia 
causes  death  in  about  one-third  the  cases. 

Treatment. — The  treatment  for  chronic  albuminuria  is  in  the  main 
hygienic.  liesidonce  in  a  warm  and  equable  climate.  A  quiet  life  with- 
out mental  worry,  with"  gentle  but  not  excessive  exercise,  is  recommended. 
In  addition  the  bowels  should  be  kept  regular,  skin  active  by  daily  tepid 
bath  with  friction.  Abundant  pure  water  or  some  pleasant  mineral  water 
should  be  drunk.  The  underclothing  should  be  wool  or  silk,  and  the  diet 
non-nitrogenous,  and  in  severe  cases  absolute  diet  of  skimmed  milk  will 
prove  beneficial,  unless  dropsy  or  symptoms  of  uremia  require  active 
remedies. 

"Further  Treatment. — Sliould  the  former  be  very  troublesome,  and 
diuretics,  as  suggested  when  speaking  of  the  acute  form,  fail  to  act,  as 


BLOODY    TTRINE.  603 

frequently  happens,  recourse  must  be  had  to  the  hydrogogue  cathartics, 
such  as  a  quarter  of  a  grain  of  elateriuin,  already  spoken  of,  with  hot-air 
or  vapor  baths  to  j)romote  elimination  by  the  skin,  as  a  partial  substitute 
for  the  inefficient  work  of  the  crippled  kidneys.  If  marked  symptoms 
of  uremia  appear,  such  as  headache,  drowsiness,  involuntary  muscular 
twitchings,  sudden  and  violent  vomiting  and  diarrhcEa,  recourse  to  the 
active  cathartics  should  be  had  at  once,  without  any  preliminary  trial  of  a 
diuretic,  and  if  \iremic  convulsions  or  coma  come  on,  full  doses  of  elate- 
rium  or  a  drop  of  croton  oil  will  probably  be  required  immediately  to  avert 
death.  During  the  convulsion  chloroform  may  be  given  by  inhalation 
to  restrain  the  violence,  and  perhaps  shorten  the  pai'oxysm. 

Many  cases  of  uremia  are  benefited  and  life  prolonged  by  blood 
letting  of  from  six  to  twelve  ounces,  depending  upon  the  pulse,  and  fol- 
lowed by  an  injection  of  saline  solution  from  one  to  two  pints  beneath  the 
breasts,  or  in  subcutaneous  structures  of  the  axilla,  strength  of  solution 
about  one  teaspoonful  of  salt  to  a  pint  of  distilled  water,  to  be  injected 
at  about  the  temperature  of  100  degrees  Fahrenheit.  Care  must  be  taken 
to  thoroughly  cleanse  the  skin  at  the  jioiut  at  wliich  the  needle  is  to  be 
inserted.     Early  in  the  case  Bascliam's  mixture  does  good. 

HEMATURIA  OR  BLOODY  URINE. 

This  is  more  a  symptom  of  other  diseases  than  a  disease  in  itself. 
Causes — Stevens  gives  as  the  causes  thus: 

1.  Vicarious  menstruation. 

2.  Traumatism  applied  to  any  part  of  the  genito-urinary  tract. 

3.  General  blood  dyscrasia  as  in  sijecific  fevers,  jiurpura,  malaria, 
scurvy,  etc. 

4.  Congestion  of  the  kidney  from  chronic  heart,  lung  or  liver  disease. 

5.  Acute  inflammation  of  any  part  of  the  genito-urinary  tract. 

6.  Stone  in  any  part  of  the  genito-urinary  tract. 

7.  Varicose  veins  in  neck  of  bladder. 

8.  It  may  occur  without  obvious  cause. 

9.  Parasites  in  genito-urinary  tract. 
10.  Tumors  and  tubercle  of  the  kidney. 

The  presence  of  blood  may  be  suspected  from  the  red,  smoky  or 
brownish  color  of  the  urine,  and  positively  determined  by  a  microscopical 
examination.  If  the  blood  is  clotted  it  generally  comes  from  the  bladder, 
and  if  coagulated  in  long  round  strings,  like  earth-worms,  it  may  have  been 


604  DISEASES   OF    THF   URINARY   SYSTEM. 

effused  in  the  uretlira,  from  a  rupture  or  ulcer  in  that  membranous  tube. 
Treatment. — The  most  inqwrtaut  thing  is  to  discover  the  cause  and 
treat  that.  If  this  cannot  be  done  tincture  of  chloride  of  iron,  which  is 
especially  useful  in  debilitated  patients  in  twenty-drop  doses  every  three 
hours,  gallic  acid  in  quantities  of  live  grains,  and  ergot,  or  two  grains  of 
acetate  of  lead  and  half  a  grain  of  opium  every  four  honrs.  The  effect 
of  the  general  remedies  may  be  aided  by  the  injection  of  a  weak  solution 
of  alum  in  cold  water,  thrown  into  the  bladder  by  means  of  a  catheter  if 
the  case  is  urgent.  Where  a  large  mass  of  coagulated  blood  is  formed  in 
the  bladder  it  may  sometimes  be  gotten  rid  of  by  the  injection  of  a  solu- 
tion of  pepsin,  which,  if  the  ingenious  plan  succeeds,  dissolves  the  clot  of 
blood. 

PYURIA  OR  PUS  IN  THE  URINE. 

Causes — 1.   Suppurative  inflammation  of  the  kidney. 

2.  Calculus  (stone)  or  tuberculosis  of  kidney. 

3.  Cystitis  or  suppurative  inflammation  of  the  bladder. 

4.  Urethritis.    Inflammation  of  urethra. 

Symptoms. — Urine  is  alkaline  and  has  a  cloudy  sediment.  There  is 
usually  frequent  and  urgent  desire  to  urinate,  especially  if  the  pus  is 
from  the  bladder  or  posterior  urethra. 

Diagnosis. — Diagnosis  can  only  positively  be  made  from  microscopical 
examination.  If  from  abscess  of  kidney  flow  of  pus  is  intermittent.  If 
from  calculus  or  tuberculosis  of  kidney  the  flow  is  constant,  as  it  is  in 
cystitis  or  urethritis. 

Treatment. — The  treatment  consists  in  removing  the  cause. 

SUPPRESSION  OF  THE  URINE. 

Description. — This  is  an  affection  in  which  the  work  of  the  kidneys 
in  secreting  the  urine  is  very  defective  or  altogether  abolished.  There 
may  be  some  pain  in  the  back  or  irritability  of  the  bladder,  the  patient 
becomes  anxious  and  restless,  then  dull  and  drowsy,  and  finally  after  an 
interval  of  from  three  to  eight  days  usually  dies  comatose.  In  other  in- 
stances there  is  nausea  and  vomiting,  hiccough,  and  the  whole  -body  ex- 
hales a  urinous  odor.  Where  the  suppression  is  less  complete,  and  depends 
upon  some  obstruction  to  its  outflow  in  the  ureters,  bladder,  or  urethra, 
tlif  mind  remains  clear  for  a  long  time,  perhaps,  and  the  unfortunate 
patient  is  fully  conscious  of  the  intense  local  suffering  and  general  dis- 


FI-OATING  OB  MOVABLE  KIDNEY. 


605 


tress  produced.  The  time  during  which  the  urine  may  be  suppressed  and 
yet  the  patient  recover  varies  considerably. 

Hysteria. — In  hysteria,  cases  where  no  urine  has  been  passed  for  ten 
days  are  reported,  but  such  instances  are  not  free  from  suspicion  of  pos- 
sible deception  on  the  part  of  the  patient.  Children  when  teething  will 
sometimes  for  days  together  void  only  a  few  drops  of  urine  at  once,  and 
that  at  several  hours'  interval.  The  urine  passed  at  such  times  is  ex- 
tremely high  colored,  stains  the  linen,  and  is  passed  with  great  pain,  the 
child  crying  bitterly,  as  it  scalds  the  sensitive  surface  over  which  it  flows. 
This  disease  probably  arises,  at  least  in  some  instances,  from  over-con- 
gestion of  the  kidney. 

Treatment — The  treatment  recommended  is  to  place  the  patient  in  a 
warm  bath,  and  give  a  saline  diuretic,  such  as  a  teaspoonful  of  cream  of 
tartar,  or  twenty  grains  of  acetate  of  potash  dissolved  in  half  a  pint  of 
water,  combined  with  a  moderate  laxative.  The  sweet  spirits  of  nitre,  in 
half  teaspoonful  doses,  is  also  frequently  Tiscful.  Digitalis  leaves  made 
into  a  poultice,  or  the  tincture  of  digitalis  added  to  a  flaxseed  poultice, 
have  often  proved  beneficial,  and  the  digitalis  may  also  be  used  internally 
with  advantage  in  the  form  of  a  teaspoonful  of  infusion  every  four  hours, 
or  Dover's  powder,  ten  grains  for  an  adult. 

riOATING  OR  MOVABLE  KIDNEY. 

The  mobility  of  the  kidney  depends  upon  the  relaxation  of  the  sur- 
rounding structures. 

Causes. — Females  are  most  usually  affected,  probably  due  to  the  dif- 
ference in  dress  between  them  and  the  males.  Middle  life.  Any  disease 
producing  rapid  marked  emaciation  predisposes  to  it.  A  congenital  i-elaxa- 
tion  of  surrounding  tissues.     Muscular  exertion.     Eepeated  pregnancies. 

Diagpnosis  is  made  by  feeling  kidney  in  abnormal  position. 

Symptoms — There  is  a  dragging  sensation  in  back.  Kidney  may  be- 
come swollen  and  jtainful  to  the  touch.  There  is  a  sense  of  uneasiness 
and  attacks  of  neuralgic  pains.  Emotional  disturbances  are  often  excited 
by  this  condition. 

Treatment. — Use  abdominal  binder  or  pad.  Eegulate  diet.  Avoid 
exertion.    If  the  condition  persists  the  only  treatment  is  surgical. 


606  DISEASES    OF   THF   UKINARY   SYSTEM. 


RENAL  OR  NEPHRITIC  COLIC. 


Causes. — Since  the  ureters  commence  inside  the  kidneys  as  funnel- 
shaped  tuhes,  it  is  obvious  that  any  solid  substance  capable  of  entering 
the  upper  part  and  yet  a  little  too  large  to  pass  the  lower  portion,  will 
stick  fast,  and  can  only  progress  as  the  pressure  of  the  constantly  secreted 
urine  behind  it  drives  it  along  with  sufficient  force  to  dilate  the  pipe  and 
allow  it  to  move  onward.  This  process  of  dilatation  is  horribly  painful, 
and  with  that  of  passing  a  gall-stone,  and  of  certain  forms  of  neuralgia, 
makes  up  the  worst  physical  suffering  of  humanity  since  the  Spanish 
Inquisition  was  abolished.  The  little  stones  which  cause  such  agony  in 
this  way  are  generally  composed  of  uric  acid,  or  less  commonly  of  oxalate 
of  lime,  deposited  from  the  urine  inside  the  kidneys,  and  washed  down 
from  the  seat  of  their  formation  by  the  outflow  of  that  fluid.  It  is  not 
positively  determined  whether  they  crystallize  out  of  the  urine  because 
they  are  produced  in  too  large  quantity  in  the  system,  or  because  a  de- 
ficient amount  of  water  to  hold  them  in  solution  is  filtered  out  of  the 
blood;  but  in  either  case,  increasing  the  bulk  of  the  renal  secretion  by 
drinking  a  larger  quantity  of  water  daily,  is  a  most  rational  method  for 
diminishing  the  tendency  to  their  production. 

Symptoms. — The  first  symptom  of  an  attack  of  renal  or  nephritic 
colic  is  usually  pain  in  the  region  of  the  loin  on  the  affected  side.  This 
rapidly  increases  in  severity  until  it  becomes  excruciating,  and  radiates 
downward  toward  the  groin,  the  testicle  on  that  side  being  drawn  up,  a 
symptcT>i  constituting  in  males — who  arc  chiefly  the  subjects  of  this 
malady — an  important  diagnostic  sign.  With  the  pain,  nausea  and  vomit- 
ing are  ajit  to  occur,  and  llic  body  is  covered  with  a  cold  sweat. 

Treatment — The  treatment  of  nephritic  colic  is  to  relieve  the  pain,  if 
only  moderately  severe,  by  hypodermic  injections  of  morphia  and  atropia, 
or  laudanum  enemas,  as  advised  in  the  article  upon  gall-stones;  but  if 
the  suffering  is  intense,  by  the  inhalation  of  ether  or  chloroform.  In 
order  to  mitigate  the  pain  sufiiciently  by  these  anesthetics,  it  is  not  usually 
needful  to  administer  them  to  complete  unconsciousness.  A  few  whiffs 
will  lull  the  distress  so  as  to  make  it  endurable  for  the  time,  and  as  this 
blessed  influence  passes  off,  it  can  be  renewed  by  a  repetition  of  the  in- 
halation. Persons  whose  hearts  and  lungs  are  healthy,  can  thus  be  kept 
in  comparative  comfort  with  comparative  safety,  for  several  hours,  or 
until  the  passage  of  the  stone  out  of  the  lower  end  of  the  ureter  into  the 
bladder  renders  the  anesthetic  no  longer  necessary. 


INTLAMMATION  OF  THE  BI.ADDKE. 


607 


Passage  of  Stone. — It  is  probable  that  both  morphia  and  ether  tend, 
besides,  to  hasten  the  exit  of  the  stone  bj  relaxing  the  spasm,  which  no 
doubt  is  caused  by  the  irritation  of  the  angular  corners  of  the  cruel  little 
calculus  as  it  makes  its  way  through  the  slender  and  sensitive  tube  of  the 
ureter.  After  the  passage  of  a  stone  of  this  kind  into  the  bladder,  it 
usually  is  voided  with  the  urine,  in  the  course  of  the  next  day  or  two. 
and  in  order  to  make  sure  that  the  enemy  has  been  completely  gotten  rid 
of,  it  is  best  to  carefully  examine  all  the  urine  which  comes  away  in  the 
next  few  days  after  an  attack.  The  character  of  the  stone,  when  found, 
will  aiford  some  information  as  to  the  best  mode  of  treatment  to  be 
adopted  for  the  purpose  of  avoiding  the  formation  of  others  of  like 
structure. 

Prophylactic  Treatment — Those  who  are  subject  to  attacks  of  nephritic 
colic  shoiild  live  a  quiet  life,  avoiding  exertion  as  far  as  possible.  The 
diet  should  be  regulated  as  in  gout.  Diuretics  should  be  taken  and  water 
in  large  quantities. 

Sir  William  Roberts  recommends  what  is  known  as  the  solvent  treat- 
ment. Citrate  of  potash  in  doses  of  half  to  one  drachm  every  three  hours. 
Osier  has  not  found  this  satisfactory.  Piperazine  in  doses  of  five  grains 
three  times  a  day  may  prove  useful  as  a  solvent. 

CYSTITIS  OR  INFLAMMATION  OF  THE  BLADDER. 

Symptoms  of  Acute  Cystitis. — There  is  great  frequency  and  urgent 
desire  to  urinate.  The  passage  of  very  little  urine  at  each  act,  accom- 
panied by  great  pain  above  the  pubis,  and  in  the  perineum  radiating  to 
the  end  of  the  penis  and  in  the  loins  and  sacral  region. 

The  Urine. — The  urine,  at  first  clear,  loses  its  transparency,  becomes 
full  of  thick  mucus  and  contains  blood  and  pus.  A  rectal  examination  is 
very  painful. 

Treatment — In  treatment  of  cystitis  remove  the  cause  if  possible. 
Put  patient  to  bed,  apply  hot  applications  to  perineum,  give  suppositories 
containing  opium,  one  grain,  and  belladonna,  one-sixth  of  a  grain.  Hips 
should  be  elevated  and  bowels  opened  by  salines  and  glycerine  enemas. 
Au  exclusive  milk  diet  is  often  beneficial. 

For  the  pain  give  a  powder  containing — 

Extract  liyoscyamus    4  grains 

Extract   cannabis   indica    4  grains 

Sugar    20  grains 

Divide  info  ten  powders,  and  take  one  every  three  hours. 


608  DISEASES   OF   THE  UKINARY  SYSTEM. 

Or  five-grain  doses  of  I'onnin  in  half  glass  of  water  tlirce  or  four 
times  a  day. 

Suppositories  of  ichthyol,  one  grain,  are  often  beneficial.  All  alco- 
bolic  stimulants  must  be  avoided. 

Symptoms  of  Chronic  Cystitis. — In  this  condition  there  is  frequent 
urination,  but  it  is  not  so  marked  as  in  the  acute  form.  The  urine  is  am- 
moniacal,  fetid  and  filled  with  tenacious  mucus  and  pus ;  not  infrequently 
blood.  Constitutional  symptoms  rarely  appear.  Tuberculosis  is  a  fre- 
quent cause  of  cystitis,  and  by  careful  straining  and  examination  the 
bacillus  tuberculosis  can  be  foimd.  This  form  is  accompanied  by  pyuria 
(passage  of  urine)  and  pain. 

Treatment — 1.  If  possible,  the  cause  must  be  removed.  Water  is 
drunk  in  large  quantities.  Salol  and  boric  acid,  five  grains  each,  every 
four  hours,  is  very  good. 

2.  Urotropin,  five  gi-ains  six  times  a  day,  catheterize  twice  a  day, 
and  irrigation  of  the  bladder  with  solution  of  silver  nitrate,  one  grain  to 
a  pint  of  water,  or  solution  of  permanganate  of  jwtassium  (1-20,000). 
The  bladder  is  washed  oiit  by  attaching  a  glass  nozzle  to  the  catheter  at 
one  end,  and  to  a  funnel  -with  rubber  tube  at  the  other.  The  funnel  is 
raised  to  four  or  six  feet  above  the  patient,  and  bladder  filled,  and  then 
fluid  allowed  to  flow  out.  This  is  repeated  several  times  until  it  returns 
clear. 

CALCITLTJS,  GRAVEL  OR  STONE  IN  THE  BLADDER. 

This  is  an  extremely  painful  and  annoying  disease  caused  by  stone 
or  stony  deposit  in  the  bladder.  "When  the  system  is  healthy  the  ingredi- 
ents forming  gravel  or  stone  are  carried  off  without  difiiculty  by  the  secre- 
tion of  the  kidneys.  But  when  there  is  excess  of  uric  or  any  other  acid 
these  particles  sometimes  unite  and  gradually  grow  and  many  find  deposit 
in  the  kidneys  or  bladder. 

It  is  supposed  by  some  authorities  to  be  in  part  due  to  the  lime  and 
magnesium  contained  in  the  hard  water  used  for  drinking  in  certain 
districts.    It  is  more  common  in  men  than  in  women. 

Symptoms. — Small  gravel  stones  may  pass  off  with  the  urine,  some- 
times with  great  pain,  others  remain  to  grow  into  stone.  Wben  the  gravel 
or  stone  is  too  large  to  pass  through  the  urethra  the  patient  is  subject  to 
terrific  spasms  of  pain,  in  groin,  kidney,  testicles,  thigh  and  abdomen, 
but  generally  pointing  to  the  direction  which  the  stone  seeks  an  exit ; 
nausea  and  vomiting  sometimes  set  in.  and  the  pulse  becomes  weak  and 
complexion  pala     The  patient  is  rendered  uneasy  by  frequent  desires  to 


STRICTURE    OF    THE    UKETHRA.  609 

pass  uriue.  The  flow  of  iiriue  is  often  sudJeuly  stopped  and  then  resumed 
upon  change  of  position.  This  is  due  to  the  stone  obstructing  the  passage 
of  urine  at  the  neck  of  the  bladder. 

Treatment. — The  medical  treatment  is  only  palliative,  and  similar 
to  that  recommended  in  cystitis  and  solvent  in  nephritic  colic.  The  sur- 
gical operation  of  opening  the  bladder  and  taking  out  the  stone,  called 
lithotomy,  and  of  lithotrity  or  crushing  the  stone,  if  of  suitable  size  and 
texture,  within  the  bladder,  by  means  of  a  very  ingenious  instrument, 
afford,  when  successful,  as  they  are  in  a  large  proi>ortiou  of  cases,  a. 
complete  cure. 

In  acute  forms  warm  baths,  suppositories  of  a  grain  of  opium  and 
one-sixth  of  a  grain  of  belladonna,  flaxseed  tea  and  the  iise  of  salty  jjur- 
gatives  are  recommended. 

In  chronic  gravel,  teas  or  fluid  extracts  of  buchu  are  often  used,  and 
in  stublxirn  cases  five-drop  doses  of  diluted  nitromuriatic  acid,  or  salicin 
in  five-grain  doses,  thi-ice  daily,  may  be  given. 

Relief  may  sometimes-  be  obtained  from  a  mixture  of  two  teaspoon- 
fuls  of  powdered  borax  and  five  of  cream  of  tartar,  dissolved  in  a  pint 
of  water,  the  doses  being  t"wo  or  three  dessertspoonfuls  four  times  a  day. 

To  relieve  intense  pain  the  following  enema  may  be  used: 

Thin-boiled  Starch 2  ounces 

Laudanum 30  drops 

This  injection  must  be  retained  in  the  bowels  as  long  as  posible.  If 
pain  is  very  severe,  put  in  forty  drops  of  laudanum.  In  place  of  this 
injection  thirty  drops  of  laudanum  may  be  given  internally  every  six 
hours,  but  the  warm  enema  is  better.  Hot  compresses  over  the  abdomen 
and  back  are  also  useful. 

STRICTURE  OF  THE  URETHRA- 

Causes. — Usually  the  attention  is  attracted  by  the  circumstance  that 
the  desire  to  urinate  becomes  more  frequent,  and  the  force  of  the  stream 
diminishes,  so  that  the  renal  secretion  dribbles  away  in  drops,  or  runs 
off  in  a  very  fine  stream  not  larger  than  a  knitting-needle.  There  is 
more  or  less  pain  in  passing  water,  and  a  good  deal  of  straining  is  required 
to  accomplish  the  operation,  which  begins  to  be  dreaded  from  day  to  day, 
and  even  from  hour  to  hoiir. 

Treatment. — The  treatment  of  stricture  is  purely  surgical,  as,  being  a 
mechanical  obstruction,  medicines  can  accomplish  nothing  for  its  relief. 
29. 


61C  DISEASES   OF   THE  UKINAHY  SYSTEM. 

The  usual  method  is  hy  gradual  dilatation,  using  first  a  small  steel  rod 
bent  at  the  suitable  curve  and  highly  polished.  This  is  to  be  warmed  and 
thoroughly  oiled,  and  then  carefully  passed  into  the  bladder  through  the 
urethra,  scarcely  any  force  being  employed.  The  great  danger  is  that 
some  of  the  inflamed  and  softened  tissues  in  the  neighborhood  of  the 
obstruction  may  give  'way,  and  what  is  called  a  false  passage  being  formed, 
the  condition  of  the  patient  is  rendered  far  worse  than  before. 

Using  the  Steel  Rod. — The  largest  size  that  can  be  used  successfully 
having  been  introduced,  it  is  allowed  to  remain  a  few  minutes  and  then 
an  instrument  of  a  little  greater  diameter  is  employed,  and  so  on  until 
the  urethra,  not  without  considerable  suffering,  is  stretched  to  the  original 
magnitude.  In  most  instances,  however,  this  dilating  process  must  be 
kept  up  for  months,  the  patient  himself  learning  how  to  use  the  proper 
iiistrument,  and  introducing  it  at  longer  and  longer  intervals  for  a  year  or 
two  until  completely  cured  Various  other  methods  for  relieving  the 
obstruction  of  stricture  have  been  devised,  such  as  external  incision, 
cauterization,  and  so  fortli. 

Emergency  Treatment — In  the  emergency  of  an  attack  of  retention  of 
urine,  in  a  man  who  is  the  subject  of  stricture,  coming  on  whilst  far  from 
m.edical  assistance,  the  first  thing  to  do  is  to  get  into  a  warm  bath,  since 
this  will  often  procure  sufficient  relaxation  of  the  spasm,  which  always 
makes  up  part  of  the  narrowing  of  an  irritated  stricture,  to  allow  a  little 
urine  to  dribble  away,  perhaps  whilst  bathing,  and  so  relieve  the  distress 
of  the  patient.  If  this  fails  a  laudanum  and  belladoima  injection  or  sup- 
pository, or  a  full  dose  of  twenty  drops  of  laudanum,  will  frequently  have 
the  desired  relaxing  effect,  or  ten  grains  of  Dover's  powder. 

Self-Use  of  the  Catheter. — Care  should  be  taken  to  drink  as  little  fluid 
as  possible,  so  as  to  diminish  the  amount  of  the  renal  secretion  to  a 
minimum,  imtil  the  avenue  for  its  escape  is  again  partially  unclosed.  If 
a  catheter  can  be  procured,  the  patient  should  try  to  pass  it  himself,  choos- 
ing the  time  when  he  is  still  partly  under  the  influence  of  the  opium,  which 
dulls  the  excessive  sensibility  of  the  urethra. 

Substitute  for  Catheter — In  the  absence  of  a  catheter  it  has  been  most 
ingeniously  suggested  by  Dr.  Levis,  of  Philadelphia,  to  use  a  piece  of 
bell-wire,  doubled  and  bent  to  the  right  curve,  along  the  sides  of  which, 
if  safely  introduced,  euough  urine  might  flow  to  relieve  the  over-distended 
bladder. 


GONOEEHEA.  611 


DISEASES  OF  THE  PROSTATE  GLAND. 

Causes  and  Cure. — Among  the  diseases  of  the  j^rostrate  gland  tlie  most 
important  are  chronic  enlargement  and  calcuhis.  This  gland  is  situated 
just  in  front  of  the  neck  of  the  bladder,  and  encircles  its  outlet,  the 
urethra.  Hence  its  enlargement  is  apt  to  interfere  with  the  outflow  of 
the  urine  from  the  bladder  as  soon  as  it  increases  beyond  a  certain  point. 
The  difficulty  thus  caused  in  passing  Avater  is  especially  apt  to  affect  elderly 
men,  and  would  be  very  serious  had  not  surgical  science  supplied  a 
jjeculiarly  formed  instrument,  called  the  prostatic  catheter,  by  which  the 
impediment  can  usually  be  overcome  temporarily. 

Inflammation  of  Tlrethra. — The  urethra,  which  constitutes  the  final 
channel  through  which  the  renal  secretion  flows  in  making  its  exit  from 
the  body,  is  likewise  subject  to  inflammation,  and  to  obstruction  from 
calculus,  and,  most  important,  to  narrowing  in  consequence  of  inflam- 
matory action.  This  contraction  of  the  canal  is  called,  as  most  people  are 
aware,  stricture  of  the  urethra,  and  notwithstanding  the  numerous  tales 
of  accident  producing  this  trouble,  which  are  poured  into  the  credulous 
ears  of  physicians,  its  true  caiise  is,  at  least  nine  times  out  of  ten,  gonor- 
rhea, which  will  therefore  be  considered  in  this  connection.  When  a 
stricture  is  present  a  bougie  should  be  used 

GONORRHEA. 

Character. —  Gonorrhea,  or,  as  it  is  vulgarly  called,  the  clap  is  a 
specific  inflammation  of  the  urethra,  the  result  of  contagion  and  very  sel- 
dom innocently  acquired  In  the  female  it  affects  chiefly  the  vagina,  and 
frequently  extends  to  the  uterus  and  ovaries. 

Gonorrhoea  is  one  of  the  most  contagious  diseases.  It  is  caused  by  the 
germ  called  gonococcus,  discovered  by  Professor  Neisser.  It  spreads 
through  illicit  intercourse. 

This  disease  is  scarcely  less  dangerous,  and  is  more  prevalent  than 
syphilis.  It  attacks  all  ages  and  spreads  unchecked  from  one  individual 
to  another.  It  is  a  disease  born  of  immorality  and  filth,  and  is  a  menace 
to  the  eyes  of  every  child  born  of  a  woman  suffering  from  the  disease,  or 
any  person  using  or  handling  clothing,  towels,  etc.,  upon  which  the  dis- 
charges from  the  penis   (male)   and  vagina   (female)  have  collected. 

The  danger  of  gonorrhoea  and  the  main  reason  it  spreads  is  due  to  the 
fact  that  the  average  sufferer  thinks  it  a  trifling  disease,  also  that  he  de- 


G12  DISEASES   OF  THE  UKINAEY  SYSTEM. 

lays  treatment  because  he  is  ashamed  or  frightened  to  tell  his  father  or 
motlier  or  even  the  family  doctor — the  man  he  should  go  to  at  once.  Thus 
treatment  is  delayed  while  the  sufferer  becomes  worse,  uses  secretly  the 
patent  medicines  advertised,  the  family  towel,  puts  his  wash  in  the  family 
laundry,  eats  and  works  along  side  of  you  and  me,  sleeps  in  hotels,  the 
berths  of  sleepers,  ocean  liners,  etc.,  where  innocent  children  and  others 
may  come  in  contact  with  the  germs  of  this  filthy  disease. 

It  is  a  mistake  for  a  sufferer  from  gonorrhoea  not  to  consult  his  own 
physician  for  treatment,  who  will  protect  him  (much  as  he  doesn't  want 
to),  instead  of  going  to  a  physician  of  doubtful  reputation,  for  there  is  no 
disease  from  which  the  quack  reaps  such  a  harvest  as  gonorrhoea,  and  every 
one  poses  as  a  specialist  in  its  treatment. 

The  dangers  from  gonorrhoea  in  the  female  are  far  worse  than  in 
the  male,  as  it  leads  to  complications  in  the  womb,  ovaries,  etc.,  and  causes 
peritonitis  and  is  responsible  for  many  deaths  from  blood  poisoning 
following  child  birth.  But  innocent  married  women  who  suffer  from 
gonorrhoea  are  the  ones  to  be  pitied  and  suffer  the  most,  for  they  are 
ignorant  of  their  condition,  and  if  maimed  wonder  why  they  are  ill  with 
a  filthy  discharge  and  often  must  undergo  painful  operations.  They  fail 
to  receive  proper  and  early  treatment  for  modesty  holds  them  back  and 
they  blame  the  trouble  on  some  other  cause. 

Symptoms. — The  first  symptom  in  the  male  is  a  slight  uneasy  sensation 
or  tickling  at  the  mouth  of  the  urethra,  which  is  generally  felt  between 
the  second  and  seventh  day  after  exjiosure  to  infection.  On  examination 
the  organ  is  found  slightly  reddened,  and  the  natural  discharge  of  mucus 
a  little  increased,  and  more  viscid  than  usual.  These  signs  of  irritation 
soon  pass  into  those  of  inflammation,  in  which  the  redness,  heat,  pain  and 
swelling,  characterizing  that  process,  are  all  experienced  in  an  exaggerated 
form  The  discharge  becomes  thick,  yellow  or  greenish,  and  the  pain  on 
passing  water,  which  must  be  done  frequently,  is  very  severe.  Erections 
are  frequent  and  painful.  The  penis  is  bent  downward.  These  erections 
are  called  chordee.  Sweling  and  inflammation  of  the  glands  in  the  groins, 
commonly  called  a  bubo,  is  common,  but  the  irritation  seldom  goes  so  far 
as  to  result  in  suppuration  and  abscess.  Orchitis  or  inflammation  of  the 
testicle  is  more  frequently  obsei-ved.  The  disease  is  apt  to  last  under  the 
best  treatment  for  a  period  of  from  four  to  six  weeks,  and  if  n^leeted  or 
badly  managed  may  be  months  before  it  is  cured. 

Treatment- — The  most  important  part  of  the  treatment  is  rest  in  bed, 
but  as  this  cau  seldom  be  secured  the  inflamed  parts  should  be  supported 


GONOBEHEX. 


613 


by  a  suitable  suspensory  bandage.  At  first  the  treatment  must  be  that 
of  inflammation  elsewhere,  that  is  by  saline  purgatives,  such  as  a  table- 
spoonful  of  epsom  salts,  low  diet,  and  half  teaspoouful  doses  of  sweet 
spirits  of  nitre  or  ten  grains  of  Dover's  powder  to  promote  j^erspiratiou. 
Wrapjiing  the  affected  parts  in  cloths  soaked  in  a  mixture  of  four  ounces 
of  lead-water  and  two  grains  of  acetate  of  morphia,  and  covered  with  oiled- 
silk  is  useful,  and  the  injection  of  dilute  solutions  of  the  same  medicines, 
made  by  mixing  an  ounce  of  this  liquid  with  three  ounces  of  water  may  be 
cautiously  tried,  or  a  one  per  cent,  solution  of  protargal.  In  the  first  few 
days  irrigation  with  a  one  to  five  thousand  solution  of  permanganate  of 
potassium.  The  scalding  on  voiding  urine  may  be  mitigated  by  drinking 
freely  of  flaxseed  tea  containing  two  drachms  of  acetate  or  bicarbonate  of 
potash  to  the  pint,  and  a  belladonna  and  opium  suppository  at  night, 
repeated  in  two  hours  if  needful,  will  generally  prevent  much  trouble 
from  chordee.  Internally  globules  copa-kava,  one  four  times  a  day,  are 
effective  in  acute  or  chronic  conditions. 

Diet. — The  diet  should  be  rice,  bread  with  very  little  butter,  milk, 
and,  if  necessary  to  keep  up  the  strength,  soft-boiled  eggs.  Meat,  alcoholic 
and  malt  liquors,  acids  and  condiments,  are  particularly  objectionable. 

Secondary  Treatment — After  the  first  violence  of  the  inflammation 
begins  to  subside  the  injections,  such  as  silver  nitrate,  one  grain  to  six 
ounces  of  water,  or  copper  siilphate,  one-half  grain  to  the  ounce,  or  acetate 
of  lead  and  sulphate  of  zinc,  each  three  grains  to  one  ounce  of  water,  may 
be  made  stronger  gradually,  allowing  them  to  be  of  sufficient  activity  to 
produce  a  little  smarting,  lasting  not  longer  than  five  minutes,  each  time 
they  are  used.  They  should  be  employed  directly  after  each  passage  of 
urine,  provided  that  does  not  occur  oftener  than  once  in  two  hours.  At 
this  period  the  administration  of  balsam  of  copaiba  is  usually  commenced, 
and  a  good  article  of  oil  of  sandalwood  appears  to  be  even  more  efiicient 
in  checking  the  remaining  discharge,  two  capsules  of  either  remedy  being 
taken  four  times  daily. 

Third  Treatment — In  the  course  of  another  w^eek  injections  of  acetate 
of  zinc,  sulphate  of  copper  or  nitrate  of  silver,  one  or  two  grains  to  the 
ounce  of  water,  may  come  into  service  with  benefit,  but  great  care  must 
still  be  exercised  in  regard  to  errors  in  diet,  a  single  glass  of  malt  liquor 
being  frequently  sufficient  to  bring  on  a  relapse.  If  neglected  or  badly 
treated  the  malady  may  run  into  the  chronic  form,  which  is  called  gleet, 
and  often  proves  exceedingly  rebellious  to  treatment.  Five-gi-ain  doses  of 
salol,  ten  drops  each  of  tincture  of  chloride  of  iron  with  tincture  af  can- 


61?  DISEASES   OF  THE  URIXAKT  SYSTEM. 

tharides  thrice  dailj  often,  however,  succeed  in  bringing  about  a  favorable 
change,  and  the  introduction  of  a  bougie  smeared  with  belladonna  oint- 
ment three  times  a  week  is  apt  to  contribute  to  the  cure. 

Formin  Comp — There  are  few  who  cannot  recall  the  day  of  balsam, 
copaiba  and  zinc  injections.  What  a  change  in  the  treatment  of  disease 
— the  antiseptic  or  gennicidal  treatment  of  the  modern  day !  In  the  treat- 
ment of  any  disease  of  the  genito-urinary  tract  the  urine  should  be  ren- 
dered sterile.  Experiments  made  with  formin  comp.  prove  conclusively 
its  value  as  a  genito-urinary  germicide,  and  the  brilliant  results  obtained 
from  its  use  place  it  foremost  among  the  remedies  of  the  genito-urinary 
specialist.  In  gonorrhea,  acute  and  chronic,  it  serves  to  restrict  the  area 
of  infection  and  prevent  reinfection.  Obstinate  cases  that  bave  resisted 
other  treatments  should  be  placed  on  formin  comp.  in  five-grain  doses 
every  three  or  four  bours.  It  will  clear  up  the  urine  without  perverting 
its  chemical  reaction.  The  trouble  with  agents  which  make  the  urine 
alkaline  is  that  they  are  incompatible  with  the  gastric  juice  and  must  be 
given  in  doses  large  enough  to  more  than  neutralize  the  acid  of  the 
stomach.  Formin  comp.  preserves  the  acidity  of  the  gastric  juice  and  pro- 
duces an  antiseptic  irrigating  fluid  of  the  urine  without  interfering  with 
the  digestion  or  irritating  the  kidneys. 

The  Sanmetto  Treatment. — "We  have  also  another  agent  possessing 
wonderful  specific  influence  over  the  urinary  organs  when  there  is  irri- 
tation or  inflammation.  It  is  called  sanmetto,  and  is  a  combination  of 
sandalwood  and  saw  palmetto.  It  acts  as  a  great  vitalizer,  increasing  the 
strength  of  the  reproductive  organs,  hastening  their  action,  promoting 
their  secreting  jiower  and  increasing  their  size.  The  usual  dose  is  a 
teaspoonful  four  times  a  day. 

It  is  generally  recognized  by  the  profession  that  there  is  no  disease 
which  is  so  common  and  presents  as  many  dangers  to  the  human  race  at 
large  as  gonorrhea.  The  great  danger  lies  in  the  fact  that  medical  men 
are  apt  to  be  careless  about  the  treatment,  l^o  man  can  pronoimce  bis 
patient  well  and  be  sure  that  his  urethra  is  free  from  the  specific  micro- 
organism imless  he  is  able  to  make  a  thorough  bacteriological  examina- 
tion of  the  patient's  urine  and  of  any  discbarge  which  may  issue  from  his 
genito-urinary  organs.  The  great  source  of  general  infection  is  the  man 
who  is  told  that  he  is  "over  his  dose"  because  his  dischai'ge  is  apparently 
checked  and  be  is  able  to  urinate  without  using  bad  language  at  every 
dribble  of  urine.  He  is  sent  away  with  a  host  of  virulent  micro-organisms 
lying  extant  in  his  urethra. 


EPIDYDIMITIS.  615 

Track  of  Gononhea — The  urethral  inflammation  commences  at  the 
meatus  and  travels  slowlj  backward.  There  is  no  ulceration.  The  dis- 
ease tends  to  limit  itself  and  to  become  localized  at  the  bulb,  where  the 
disease  rans  its  course.  Instead  of  getting  well  we  have  gleet,  in  which 
there  is  a  certain  amount  of  sticky  fluid,  often  only  a  drop  at  the  meatus 
in  the  morning  continues  to  be  secreted  after  gonorrhea,  from  altered 
patches  of  the  urethra,  or  coming  from  the  stretched  and  congested  mem- 
brance  behind  a  stricture.  Gleet,  then,  is  a  symptom  of  two  structural 
lesions,  and  signifies  that  there  are  patches  of  congestion  in  the  canal, 
covered  or  not  by  granulations,  or  that  stricture  exists,  and  that  the  dis- 
charge comes  from  behind  it.  When  an  individual  with  a  gleet  is  found 
to  be  gouty  it  is  particularly  advisable  to  enforce  strict  urethral  hygiene. 

Gonorrheal  Complications. — Of  the  complications  of  gonorrhea  we 
may  have  inflammatory  phymosis,  chordee,  retention  of  urine  and  hemor- 
rhage. The  idea  of  aborting  gonorrhea  by  the  internal  use  of  balsams 
has  been  abandoned.  By  abortive  treatment  is  now  understood  the  injec- 
tion of  any  irritating  soluble  substance  iuto  the  uretlira  for  the  purpose 
of  inflaming  the  canal.  Of  these  substances  is  nitrate  of  silver  or  argyrol, 
of  the  strength  of  half  a  grain  to  one  oxmce  of  water,  the  injection  being 
carefully  repeated  every  two  or  three  hours  until  a  trace  of  blood  is  seen 
in  the  discharges.  Then  all  treatment  must  cease.  The  syringe  used  in 
the  abortive  treatment  should  never  hold  more  than  two  drachms,  and 
the  fluid  injected  must  be  brought  well  into  contact  with  every  portion 
of  the  first  inch  and  a  half  of  the  urethra 

In  true  gonorrhea  the  abortive  treatment  will  not  avail  after  the  dis- 
ease is  more  than  forty-eight  hours  old. 


EPIDIDYMITIS  OR  SWELLED  TESTICLE. 

Swelled  testicle  (epididymitis)  frequently  accompanies  or  follows 
gonorrhoea  and  may  appear  at  any  stage  of  the  disease,  but  it  may  result 
from  several  excesses  without  gonorrhoea,  to  the  introduction  of  instru- 
ments into  the  bladder  or  to  a  blow  upon  the  testicle.  Usually  but  one 
testicle  is  inflamed  though  occasionally  both  are  affected  and  sometimes 
the  swelling  switches  from  one  to  the  other.  Although  a  most  painful 
affection  the  disease  is  seldom  dangerous  and  usually  there  is  a  complete 
recovery. 

Symptoms. — There  is  sometimes  a  dragging  sensation  in  one  of  the 


616  DISEASES   OF   THE  URINABT  SYSTEM. 

groins,  tenderness  in  the  connecting  cord  and  pain  in  tlie  back  a  day  or 
so  before  any  actual  discomfort  is  felt  in  the  testicles.  There  is  apt  to  be 
a  chill  or  chilly  sensations  at  the  onset  of  the  disease,  but  the  unmistakable 
symptom  is  the  swelling  of  the  testicle  and  the  accompanying  severe  pain. 
The  swelling  increases  steadily  and  the  pain  correspondingly  augments, 
sometimes  being  of  an  aching  character  and  sometimes  neuralgic,  occasion- 
ally darting  to  the  hips  and  back.  Nausea  and  vomiting  are  frequently 
an  accomj)animent  of  the  swelling.  The  influenced  testicle  may  become 
swollen  to  the  size  of  a  man's  fist  and  cause  painful  tension  of  the  scrotum. 
The  duration  of  the  disease  varies.  The  severe  symptoms  usually  subside 
in  four  or  five  days,  but  the  enlargement  and  tenderness  may  continue 
for  some  weeks.  In  some  cases  where  there  has  been  considerable  inflam- 
matory deposit,  the  convoluted  portion  of  the  seminal  canal  at  the  back 
of  the  scrotum,  known  as  the  epididymus,  may  remain  in  a  hardened  state 
for  months  or  years. 

Treatment — The  patient  should  remain  in  bed,  the  scrotum  being 
elevated  in  such  manner  as  to  relieve  the  tension  of  the  cord.  This  also 
tends  to  moderate  the  rush  of  blood  to  the  testicle.  If  early  in  the  case 
the  scrotum  be  scarified  with  nitrate  of  silver  in  strong  solution  (40  to 
CO  grains  to  each  ounce  of  distilled  water)  the  pain  will  be  alleviated 
and  sometimes  completely  banished.  When  pain  is  unusually  severe  relief 
may  be  afforded  by  a  hypodermic  injection  of  morphine  under  the  skin 
at  the  location  of  the  cord.  Half  an  ounce  of  muriate  of  ammonia  and 
one  ounce  of  alcohol  in  a  pint  of  water  makes  a  lotion  which  applied  to 
the  testicle  with  absorbent  cotton,  often  gives  gratifying  relief.  A  thick, 
warm  linseed-meal  poultice  also  frequently  abates  pain.  Other  treatments 
are  lead  water  and  laudanum.  The  testicle  should  later  be  supported  by 
a  proper  bandage  or  suspensory.  Severe  tension  of  the  scrotum  may  be 
relieved  by  pricking  the  scrotum  in  such  manner  as  to  let  out  the  serum, 
but  this  should  not  be  attempted  by  anyone  but  a  competent  surgeon. 


VARICOCELE. 

Varicocele  is  a  term  used  to  designate  a  swollen  or  knotty  condition 
of  the  spermatic  or  testicle  veins.  It  occurs  in  about  ten  per  cent,  of 
males.  The  veins  when  felt  by  the  fingers  impart  an  impression  as  of 
a  bunch  of  earth  woitus  inside  the  scrotum  and  is  generally  on  the  left 
side.     Among  causes  given  are  constipation,  ungratified  desire  and  exces- 


SYPHILIS.  617 

sive  sexual  indulgence.     In  some  severe  chi-onic  cases  there  may  be  a 
washing  away  of  the  testicle. 

The  treatment  is  either  palliative  or  radical.  The  former  is  simply 
in  the  use  of  some  means  of  affording  the  patient  temporary  relief,  which 
may  be  accomplished  by  use  of  a  proper  fitting  bandage  or  suspensory, 
frequently  bathing  the  part  with  cold  water.  The  radical  cure  is  by 
cutting  or  tying  the  vessels.    Local  applications  are  not  of  material  benefit. 


SYPHILIS. 

Par-reaching  Effects. — Directly  syphilis  Is  due  to  immorality  of  In- 
dividuals and  did  it  aifect  only  the  guilty,  humanity  in  general  would  not 
be  so  much  concerned,  but  owing  to  its  nature  the  disease  is  such  that  it 
is  easily  corammiicated  to  the  Innocent.  Not  only  may  it  descend  to  off- 
spring unto  the  fourth  and  fifth  generation,  but  it  may  be  given  to  a 
mother  or  a  sister  by  a  kiss  or  may  be  conveyed  by  use  of  a  towel  or  any 
other  article  which  the  diseased  has  handled.  It  may  be  conveyed  in  so 
many  ways  that  It  is  almost  Impossible  to  give  them  In  detail,  and  thus  it 
is  that  humanity  in  general,  whether  innocent  or  guilty,  are  deeply  con- 
cerned and  should  not  only  be  on  personal  guard  but  should  act  unitedly 
to  the  end  of  isolating  victims  as  if  the  case  were  small-pox  and  so  even- 
tually suppress  the  disease. 

Cause- — It  is  a  disease  the  result  of  a  specific  poison  produced  solely 
by  direct  implantation  of  the  contagious  material,  usually  the  purulent 
discharge  from  a  venereal  sore  in  a  previously  diseased  person. 

Development — About  a  month  after  it  is  In  any  mode  implanted  in 
the  human  system  It  appears  to  begin  a  development  throughout  the  whole 
organism,  and  penetrating  to  every  part  of  the  body,  affects  especially  the 
skin,  glands  and  throat  In  the  form  of  secondary  symptoms,  and  still  later 
the  cartilages  and  bones  as  tertiary  manifestations,  until  finally,  if  un- 
checked, it  often  proves  fatal,  after  intense  and  prolonged  suffering. 

Local  Symptoms. — The  first  symptom  of  this  horrible  disease  is  usually 
a  primary  sore  or  chancre,  which  appears  as  a  small  pimple  or  blister  upon 
some  part  of  the  organs  of  generation,  or  point  of  contact,  any  time  within 
two  or  three  weeks  after  the  infection  Is  received.  The  great  distinction 
between  the  syphilitic  ulcer,  or  true  chancre,  and  the  chancroid,  or  non- 
syphilitic  sore,  is  that  the  former  has  a  hardened  base,   but  the  most 


618 


DISEASES    OF    THE    URINARY   SYSTEM. 


eminent  surgeons  admit  that  neither  this  nor  any  other  criterion  is  in- 
fallible. The  infecting  pimple  may  dry  up  without  ulcerating,  but  more 
conunonly  a  cup-shaped  sore  from  an  eighth  to  three-eighths  of  an  inch 
ill  diameter,  and  with  raised  edges,  is  formed,  and  unless  modified  by 
treatment  lasts  for  a  month  or  six  weeks,  when  it  heals  up,  leaving  a  hard- 
ened lump  of  a  dark  red  coppery  or  bronze  color,  which  is  often  several 
months  in  completely  disappearing.  The  glands  in  the  groins  during  the 
•ulcerating  stage  of  the  primary  chancre  become  swollen,  hard  and  slightly 
painful,  but  seldom  suppurate.  After  some  weeks  the  other  lymphatic 
glands  partake  of  this  enlargement,  and  gradually  those  in  the  armpit,  in 
the  neck  and  behind  the  ear  give  evidence  of  the  general  infection. 

The  Chancroid  Sore. — The  chancroid,  sofe-chancre  or  non-syphilitic 
sore,  generally  develops  in  a  few  days  from  the  date  of  infection,  first  as  a 
minute  vesicle,  then  a  pustule,  and  later  as  an  nicer,  round  or  oval  in  shape, 
with  clean-cut  edges,  and  without  any  hardening  of  the  base.  The  floor 
of  the  ulcer  is  generally  covered  with  a  thick  yellowish  matter,  which  is 
virulent  and  contagious  in  the  highest  degree.  The  glands  in  the  groins 
are  often  not  swollen,  but  if  affected  are  much  more  apt  to  suppurate,  con- 
stituting a  bubo,  the  discharge  from  which  is  also  intensely  contagious. 
It  is  therefore  far  more  troublesome  than  the  primary  syphilitic  sore,  and 
yet  infinitely  to  be  preferred  to  the  latter  on  account  of  the  absence  of 
any  constitutional  infection. 

The  following  is  a  diagnosis  between  chancre  and  chancroid: 


Chancre. 

1.  Appears  two  to  twenty  days  after  ex- 

posure. 

2.  Is   usually  single. 

3.  Inflammatory     phenomena     compara- 

tively slight. 

4.  Discharge    is    serous    or   bloody   and 

readily  inoculable. 

5.  Margins   of  preputial  orifice  are  not 

markedly  inflamed. 

6.  Marked  induration. 

7.  Buboes  are  invariably  present,  and  in 

both     groins;     tliey     rarely     sup- 
purate. 


Chancroid. 

1.  The    interval    between    exposure   and 

appearance  is  much  shorter. 

2.  May  be  multiple. 

3.  Inflammatory  phenomena,   heat,  pain, 

redness  and  swelling  very  marked. 

4.  Discharge,  profuse,  purulent,  very  ir- 

ritating  and    readily    inoculable. 

5.  Induration,  if  present,  is  not  marked. 

6.  Buboes,  if  present,  are  usually  on  one 

side,  and  suppurative. 


.  Constitutional  Symptoms;  Secondary — After  a  true  or  hard  chancre 
has  developed,  and  no  matter  whether  it  has  healed  promptly  or  is  still 
open,  there  appears  in  about  four  weeks,  on  an  average,  from  the  first 
infection  the  first  of  the  train  of  general  or  constitutional  symptoms. 
These  consist  of  the  tumefaction  of  the  lymphatic  glands,  followed  after  a 


STPHiLia.  619 

few  weets  more  by  fever,  headache,  rheumatic  pains  and  soreness  of  the 
throat.  About  the  tenth  week  after  the  dearly-bought  pleasure  its  un- 
fortunate purchaser  usually  finds  a  crop  of  eruption  appearing  upon  his 
skin,  sometimes  slight  and  easily  concealed,  but  oftener  well  defined  and 
in  a  tell-tale  abundance,  which  instantly  reveals  his  guilty  secret. 

The  Eruptions. — This  eruption  may  bo  of  pimples,  pustules,  or  scales, 
the  former  being  the  most  common  and  having  a  new  copper-colored  red 
or  brownish-red  tint,  which,  when  well  marked,  is  to  the  experienced  eye 
very  characteristic.  It  is  apt  to  be  especially  abundant  round  the  sides  of 
the  nose  and  angles  of  the  mouth  and  eyes,  the  roots  of  the  hair  on  the 
forehead  and  back  of  the  neck,  the  centre  of  the  breast,  the  inner  side  of 
the  limbs,  and  around  the  armpits  and  groins. 

Hand  and  Feet  Eruptions. — An  important  diagnostic  mark  of  the 
scaly,  syphilitic  erujition  is  its  appearance  on  the  palms  of  the  hands  and 
the  soles  of  the  feet.  These  manifestations  are  also  particularly  liable  to 
appear  as  pustules  among  the  hair  of  the  scalp.  In  some  cases  the  whole 
body  is  thickly  covered.  After  persisting  for  periods  varying  from  two 
or  three  weeks  to  as  many  months,  these  spots  usually  fade,  leaving  behind 
them  brownish  stains  which  are  very  persistent,  but  ultimately  may  give 
place  to  pale  scars,  somewhat  like  the  pitting  of  small-pox  in  a  very  mild 
fornu 

Other  Appalling  Symptoms. — In  a  minority  of  instances  the  patient 
escapes  any  well  defined  symptoms,  but  suffers  instead  from  one  of  the 
following  manifestations  of  secondary  syphilis,  which  often  accompany 
the  eruptions  also:  Alopecia  or  falling  of  the  hair,  which  in  bad  cases 
may  include  not  only  that  of  the  head,  but  also  the  eyelashes  and  eye- 
brows; flat  whitish  sores  in  the  mouth  and  anus,  called  mucous  patches, 
the  discharge  from  which  in  the  former  situation  may  easily  convey,  by 
kissing,  the  whole  vile  disease  to  a  perfectly  innocent  person;  inflamma- 
tion of  the  iris  injuring  or  even  destroying  the  sight ;  and  local  diseases  of 
the  generative  organs. 

Tertiary  Symptoms — The  late  or  tertiary  symptoms  of  venereal  dis- 
ease are  disease  of  the  cartilages  and  small  bones  of  the  nose  and  throat, 
producing  the  shocking  disfigurement  of  the  countenance  sometimes  seen, 
especially  among  sailors ;  disease  of  the  bones  of  the  skull  leading  to  per- 
sistent and  excruciating  headache,  and  sometimes  actually  perforating  the 
cranium ;  disease  of  the  tibia  or  large  bone  of  the  leg  between  the  knee 
and  ankle;  disease  of  the  nails  which  may  entirely  Tilcerate  out;  disease 
of  arteries  which,  of  course,  is  most  apt  to  prove  fatal,  and  peculiar  new 


'620  DISEASES    OF    THE    UEINABY    SYSTEM. 

growths  called  gummy  tumors,  whicli  may  appear  in  all  parts  of  the 
system. 

Congenital  (Birth)  Syphilis. — Congenital  syphilis  generally  shows 
itself  between  the  third  and  sixth  week  after  birth,  by  cutaneous  eruptions, 
similar  to  those  seen  in  the  secondary  period  of  acquired  syphilis,  and  of 
most  frequent  occurrence  upon  the  buttocks,  abdomen,  palms  and  soles. 

Symptoms — Congestion  and  subacute  inflammation  of  the  mucous 
membrane  of  the  nose,  with  increased  discharge,  vulgarly  called  the 
snuffles,  also  appear,  and  the  infant  has  usually  a  peculiarly  shriveled, 
weazened  aspect,  like  that  of  a  prematurely  old  man.  Mucous  patches 
from  about  the  baby's  mouth  may  infect  the  mother  or  nurse,  and  kera- 
titis or  inflammation  of  the  cornea  of  the  eye  is  lamentably  common. 
Early  and  active  administration  of  mercury  is  very  important  lest  the 
syphilitic  cachexia  prove  fatal. 

local  Treatment  of  Chancre. — The  treatment  of  the  primary  sore,  or 
chancre,  is  much  disjiuted.  Cauterization  with  nitric  or  trichloracetic 
acid,  or  the  acid  nitrate  of  mercury,  and  subsequent  dressing  with  black- 
wash — a  mixture  of  a  drachm  of  calomel,  and  a  pint  of  limewater — is 
much  employed;  but  the  application  of  iodoform  is  highly  recommended. 
Complete  excision  of  the  sore,  with  its  hardened  base,  in  the  hope  of 
preventing  secondary  symptoms,  has  been  tried  without  success,  even  when 
performed  early.  If  the  enlarged  glands  in  the  groins  give  rise  to  much 
discomfort,  they  should  be  painted  over  with  the  tincture  of  iodine  or 
twenty  per  cent,  ichthyol  ointment. 

Treatment  by  Caustic — The  prompt  destruction  of  the  chancroid 
ulcer  by  caustic,  and  the  dressing  with  black-wash  or  yellow-wash,  is  ad- 
visable, and  hope  may  be  entertained  of  thus  putting  an  end  to  the  whole 
malady.  If  the  glands  in  the  groins  go  on  to  suppuration,  however,  very 
serious  trouble  may  be  anticipated  before  a  cure  is  effected. 

Constitutional  Treatment. — The  treatment  of  the  secondary  symptoms 
is  by  the  iise  of  mercury,  which,  although  decried  by  some  physicians,  is 
considered  by  our  best  authorities  as  the  only  effectual  remedy  for  syphilis. 
It  may  be  administered  by  inunction  of  mercurial  ointment,  by  fumi- 
gation, or  in  the  form  of  half  a  grain  of  calomel,  or  blue  pill,  or  one-third 
of  a  grain  of  the  iodide  of  mercury  thrice  daily,  or  proTiodide  of  mercury 
one-fourth  gi-ain  three  times  a  day.  It  is  also  given  by  hypodermic  injec- 
tions of  the  bichloride,  one-third  grain,  once  a  week.  The  injection  must 
be  made  deep  into  the  muscles.  Proper  precautions  must  be  taken  to 
cleanse  the  needle  and  syringe  before  using,  also  the  skin  at  point  at  which 


SYPHILIS.  621 

the  needle  must  be  inserted.  This  treatment  should  be  kept  up  at  intervals 
for  a  year  or  two  after  an  apparent  cure  has  been  effected.  To  obtain 
its  beneficial  effects,  which  are  often  very  marked  and  satisfactory,  it  is 
not  necessary  to  induce  severe  salivation,  which,  probably,  in  former  times, 
often  aggravated  the  ultimate  effects  of  the  syphilitic  poison. 

Treatment  of  Third  (Tertiary)  Stage. — In  the  tertiary  stage,  iodine 
and  iodide  of  potassium,  in  the  form  of  the  compound  iodine  solution,  or 
the  iodide  occasionally  in  very  large  doses  of  fifteen  or  twenty  grains, 
thrice  daily,  are  the  great  remedies ;  but  they  may  sometimes  be  associated 
with  mercurials  to  much  advantage.  In  a  majority  of  instances,  the 
development  of  well-marked  tertiary  symptoms  may  be  prevented  by 
judicious  treatment  in  the  second  stage  of  the  complaint,  and  even  when 
a  slight  tendency  to  disease  of  the  bones  and  cartilages  is  displayed,  a 
combination  of  the  iodides  with  mercury  will  often  avert  disastrous  con- 
sequences, or  the  sirop  Gibert. 

TTse  of  Tonics — Throughout  the  whole  management  of  the  case  the 
administration  of  tonics,  such  as  iron,  quinine  and  strychnia  is  very  im- 
portant, and  strict  attention  to  hygiene  by  promoting  the  best  general 
health  is  an  almost  indispensable  condition  to  securing  a  favorable  result ; 
also  frequent  hot  baths. 

Should  Syphilitics  Marry? — Professor  Alfred  Fournier,  in  a  late  in- 
structive work  on  syphilis  and  marriage,  formulates  some  valuable  con- 
clusions in  regard  to  the  very  diflicult  problem,  from  a  hygienic  point  of 
view,  whether  a  syphilitic  person  ought  to  marry  or  not.  He  asserts  that 
a  man  who  enters  upon  marriage,  with  syphilitic  antecedents,  may  become 
dangerous :  first,  to  his  wife ;  second,  to  his  children ;  third,  to  the  interests 
of  his  family.  In  the  first  place  the  wife  is  apt  to  be  infected  directly  by 
contact  with  the  pus  of  secondary  lesions ;  and  Dr.  F.  says :  "I  know  from 
long  experience  that  it  is  rare  to  see  a  yoimg  wife  live  with  a  syphilitic 
man,  or  conversely,  without  the  health  of  the  former  being  effected  by 
the  diseased  one."  It  was  this  which  caused  a  witty  French  observer  to 
say:  "The  pox  is  partaken  of  by  a  married  couple  equally,  just  like  the 
daily  bread." 

Syphilis  Conveyed  by  Conception. — Secondly,  a  man  may  convey 
syphilis  to  his  wife  by  causing  conception,  as  when  a  young  girl,  pure  and 
healthy,  is  married  to  a  man  whose  venereal  disease  has  not  been  thor- 
oughly cured.  Tlie  physician  calls  a  few  months  later  and  finds  her  dis- 
eased with,  for  example,  distinct  secondary  symptoms,  such  as  cutaneous 
syphilides,  mucous  patches  in  the  month,  scabs  on  the  scalp,  swelling  of 


B22  DISEASES    OF    THE    URINAKY   SYSTEM. 

the  glands  in  tlie  neck,  headache,  vague  pains,  lassiUide,  febrile  attacks, 
loss  of  hair,  and  so  forth — all  this  without  a  trace  of  chancre,  and  even 
without  that  faithful  comiianion  of  a  chancre,  a  bubo,  which  M.  Ricord 
calls  so  aptly  the  posthumous  witness  of  a  chancre.  In  these  lamentable 
instances,  the  wife-mother  infected  without  having  had  any  primary  symp- 
toms, and  whose  husband  has  long  been  freed  from  all  external  indications, 
is  diseased,  not  from  that  husband,  except  indirectly,  but  from  her  child 
still  within  her  womb. 

Danger  to  Children — As  respects  the  danger  to  children:  Although 
offspring  may  be  begotten  by  a  syphilitic  father  who  enjoys  good  health, 
yet  the  hereditary  influence  of  paternal  syphilis  is  very  far  from  being  as 
innocent,  minute  or  negative  as  has  been  maintained. 

Development  of  the  Inherited  Tendency — This  inherited  tendency 
may  be  developed  in  the  three  following  modes :  Either  that,  which  is  an 
exceptional  case,  by  the  transmission  of  syphilis  to  the  foetus ;  or  that, 
which  is  sufficiently  common,  by  the  death  of  the  child ;  or  lastly,  by  the 
inherent  degeneration  of  the  germ,  which  ultimately  reveals  itself  under  a 
great  variety  of  morbid  conditions. 

"Worst  Form  of  Danger. — But  the  worst  form  of  danger  to  the  family 
of  a  syphilitic  father  is  that  communicating  the  disease  to  the  wife,  the 
paternal  and  maternal  influences  will  act  upon  the  same  side,  and  most 
disastrously  conspire  in  unison  against  the  fruit  of  any  pregnancies  which 
may  result.  In  such  sad  cases  we  can  predict  that,  with  a  few  rare  excep- 
tions, either,  first,  and  the  child  will  die  before  birth ;  or,  second,  it  will  be 
born  with  syphilis,  and  with  all  the  possible  and  serious  consequences  of 
infantile  syiihilis,  which  in  many  cases  are  equivalent  to  death  itself;  or 
finally,  third,  it  may  be  born  without  syphilis,  but  with  uncertain  health, 
with  a  weak  nature  and  a  feeble  constitution,  which  will  probably  expose 
it  to  a  rapid  death ;  with  menacing  morbid  tendencies ;  with  a  predisposi- 
tion to  certain  organic  diseases— in  a  word,  to  a  relatively  speedy  decay; 
this  terrible  fate  being  visited  again  and  again  upon  successive  innocent 
babes. 

Transmission  of  Syphilis — At  the  New  Orleans  meeting  of  the  Public 
Health  Association,  Dr.  Gihon  of  the  Navy,  as  chairman  of  a  committee 
on  the  subject,  presented  a  valuable  report,  in  which  he  remarked : 
"Every  one  instinctively  shrinks  from  the  touch  of  the  sufferer  with  small- 
pox, but  how  few  realize  that  a  syphilitic  is  a  leper  also  to  be  most  scru- 
pulously shunned  ?  How  few  mothers  are  aware  of  the  danger,  to  them- 
selves and  their  children,  from  nurses  and  housemaids  drawn  from  a  part 


STPHILI3.  '62S 

of  the  population  in  which  every  fifteenth  person  is  thus  diseased  ?  How 
few  parents  suspect  the  peril  to  their  daughter  from  her  accepted  lover's 
kiss,  since  he  may  be  that  one  in  about  every  five  young  men  among  the 
better  classes  who  has  a  venereal  disease,  which  there  is  one  chance  in 
two  is  sypliilis." 

Transmission  of  Syphilis  by  Kissing — These  are  not  mere  speculations, 
for  Professor  Gross  reports  that  he  has  seen  many  cases  communicated  by 
kissing;  and  he  tells  of  fifteen  women,  nine  children,  and  ten  men  diseased 
by  a  single  midwife,  who  had  a  chancre  on  her  finger,  contracted  in  the 
exercise  .of  her  profession,  and  who  had  thus  carried  the  disease  from 
house  to  house. 

Transmission  by  Cooks  and  Nurses. — Dr.  J.  Marion  Sims  says:  "I 
have  seen  a  cook  and  a  chambermaid  with  syphilitic  ulcers  on  their  fingers  ; 
I  have  seen  nurses  infected  by  the  children  they  had  nursed,  who  were 
born  of  syphilitic  parents,  in  turn  infecting  sucking  babes,  born  of  healthy 
parents;  and  I  have  known  a  drunken  vagabond  husband  to  contract 
syphilis  and  communicate  it  to  his  wife,  who  in  turn  gave  it  imwittingly 
to  her  four  children,  simply  by  using  the  same  towels  and  washbowl." 

Transmission  by  Towels — One  of  this  very  committee  adds  the  case 
of  an  estimable  and  venerable  lady,  who  lost  her  eyesight  that  year,  from 
a  venereal  affection  arising  from  using  a  towel  in  her  son's  room,  care- 
lessly left  by  him  upon  the  rack ;  and  of  another,  the  wife  of  a  clergyman, 
who  the  preceding  summer  sought  relief  at  a  Virginia  spring  for  a  hor- 
rible affection  contracted  in  domestic  contact  with  her  servant. 

Transmission  by  Pipes  and  Cigars.— The  present  Surgeon-General  of 
the  Navy  saw  a  number  of  cases  of  chancre  of  the  lips  among  the  smokers 
of  one  set  of  cheroots,  of  which  the  M'rappers  had  been  moistened  by  the 
saliva  of  a  Manila  cigar  girl ;  and  at  Beyroot  he  learned  that  it  was  not 
unusual  for  syphilis  to  be  contracted  by  using  a  narrjliileh  that  had  been 
pressed  by  the  lips  of  a  diseased  smoker.  How  many  people  would  venture 
to  eat  Smyrna  figs  if  they  had  seen  the  top  layer  of  the  choicest  box  pressed 
flat  with  the  saliva-wetted  thumb  of  the  packer,  who,  there  was  one  chance 
in  ten,  was  a  syphilitic  ? 

Transmission  by  Exhalation — A  certain  lady  was  terribly  alarmed 
when  told  by  her  husband,  a  physician,  that  she  had  invited  to  her  tabic  a 
young  man  who,  in  the  course  of  a  physical  examination  that  morning, 
he  had  found  to  have  his  mouth  and  tongue  covered  with  mucous  patches ; 
and  that  her  daughter  was  dancing  in  a  public  ballroom  with  another 
whose  body  was  repulsive  with  syphilitic  eczema. 


624;  DISEASES    OF    THE    UEINAET   SYSTEM. 

Transmission  by  Instruments — An  editorial  in  one  of  our  Philadel- 
phia medical  journals  not  long  since  stated:  "It  has  happened  to  the 
writer  to  be  recently  called  to  see  a  man  of  most  respectable  surroundings, 
■who  bore  an  unmistakable  venereal  sore  upon  his  lip,  and  subseqiiently 
manifested  all  the  features  of  secondary  syphilis.  It  was  said  that  this 
sore  had  followed  a  trifling  surgical  operation  upon  the  part  ailected  for 
the  removal  of  a  slight  deformity,  during  which  the  instruments  or  the 
hands  of  the  surgeon  had  inoculated  him  with  syijhilis. 

Ever-Present  Dangers. — This  energetic  committee  urged  that  it  should 
be  promulgated  evcryvi'here  throughout  the  community,  that  so  long  as 
syphilitics  are  allowed  to  go  unrestrained  the  spotless  woman  and  the 
innocent  child  share  the  danger  of  this  horrible  contamination  with  the 
libertine  and  the  courtesan. 

The  Various  "Ways  of  Transmitting  Syphilis Let  it  be  known  by  every- 
one, they  exclaim,  that  this  fearful  pest  may  be  communicated: 

1.  By  the  blankets  of  the  sleeping  car,  the  sheets,  towels  and  napkins 
of  the  steamship,  hotel  and  restaurant. 

2.  By  the  hired  bathing  dresses  at  a  seaside  resort,  and  the  costumes 
rented  for  the  fancy  ball. 

3.  By  the  chipped  edges  of  cups  and  plates,  as  seen  at  any  hotel  or 
eating  house,  and  by  the  half-cleansed  knives,  forks  and  sjioons  of  the 
same. 

4.  By  public  drinking  vessels  in  a  railway  car  or  station,  as  well  as 
the  public  urinal  or  water-closet. 

5.  By  the  barber's  utensils,  the  comb  and  brush  in  the  guest  chamber, 
the  hatter's  measure,  or  the  borrowed  hat. 

6.  By  the  surgeon's  and  dentist's  instruments,  or  the  vaocinator'a 
lancet. 

7.  By  the  broom  or  dust-brush  handled  by  a  parlor  maid,  or  by  the 
spoon  or  cup  touched  by  the  mouth  of  a  cook  or  nurse. 

8.  By  whistles  and  other  toys  sold  to  children  in  the  streets  by  ven- 
dors with  poisoned  lips  or  fingers. 

9.  By  playing  or  visiting  cards  which  have  been  used,  and  especially 
by  car  tickets  and  paper  money  circulating  in  a  city  like  Philadelphia, 
where  50,000  syphilitics  are  at  large. 

10.  By  the  grasp  of  a  friend's  hand  or  the  kiss  of  a  betrothed  lover, 
by  the  son  to  his  mother  and  sister,  the  husband  to  his  wife  and  unborn 
child,  and  by  the  latter  to  its  mother. 


SYPHILIS.  625 


SYPmilS— A  VEGETABLE  TREATMENT. 

Hematesene. — Under  tlie  former  methods  of  treatment  there  was  no 
remedy  in  the  pharmacopoeia  "which  could  be  relied  upon  as  a  specific  for 
syphilis,  although  there  were  many  that  had  a  very  beneficial  influence  in 
aiding  the  disappearance  of  the  symptoms.  It  was  then,  indeed,  a  question 
whether  the  disease  could  ever  be  effectually  cured. 

Mercury  Not  Relied  On. — In  former  times  it  was  thought  that  in  mer- 
cury we  possessed  a  specific  against  the  disease,  and  when  aU  sores  were 
looked  upon  as  syphilitic,  and  mercury  was  administered,  a  large  pro- 
portion of  supposed  cures  were  recorded.  In  our  modern  times,  however, 
the  supposed  success  of  the  mercurial  plan  is  not  recognized. 

The  New  Specific. — Recent  investigation  and  research  have  brought 
to  light  a  remedy  called  hemetesene,  which  is  as  much  a  specific  for 
syphilis  and  blood-poisoning  as  quinine  is  for  intermittent  fever.  Mer- 
cury and  the  iodides  produce  injurious  effects  if  long  continued,  and 
should  be  avoided.  Patients  who  have  been  treated  by  the  old  plan  im- 
prove rapidly  after  taking  hemetesene.  In  some  patients  an  itching  is 
produced;  in  others  an  eruption  on  portions  of  the  body  or  limbs;  in  a 
few  watery  blisters  in  the  palms  of  the  hands  and  soles  of  the  feet  which 
require  no  particular  attention  except  to  cleanse  them  with  water,  adding 
a  few  drops  of  carlx)lic  acid. 

Comparison  of  Treatments. — This  vegetable  treatment  is  a  certain  anti- 
dote to  blood-poison,  and  increases  the  number  of  red  corpuscles  in  poor 
blood,  while  mercury  and  the  iodides  often  produce  a  rim-down  condition 
of  the  system  if  taken  for  a  length  of  time. 

Effect  of  This  Vegetable  Treatment. — The  effect  of  hematesene  as  a 
constitutional  remedy  rests,  unquestionably,  in  its  power  of  eliminating 
specific  poison  from  the  blood,  and  in  its  tonic  power,  increasing  the  pro- 
portion of  red  corpuscles  in  impoverished  blood,  thus  enabling  the  system 
to  throw  off  disease. 

ANOTHER  TREATMENT  FOR  SYPHILIS. 

Salvarsan  606  Antisyphilitic  Remedy. 

Many  observers  at  the  present  time  are  experimenting  vnth  this  new 
remedy  brought  before  the  medical  profession  by  Dr.  Ehrlich,  of  (term any. 
The  opinions  of  the  profession  at  present  vary  as  to  whether  we  have  a 
40 


626  DISEASES    OF    THE    tTRINART   SYSTEM. 

specific  for  the  cure  of  syphilis.  At  present  it  has  proven  successful  in 
quite  a  number  of  cases,  while  some  physicians  have  reported  bad  eilects 
following  its  use.  The  following  will  give  a  resume  of  the  facts  developed 
at  this  time,  and  also  the  mode  of  treatment.  Of  course,  it  should  not  be 
administered  by  anyone  except  a  qualified  physician.  Syphilis  is  an  in- 
fection of  the  system  by  spiroclioeta  pallida.  This  is  one  of  the  protozoal 
type  of  organism,  such  as  malaria,  relapsing  fever,  etc.  The  pathological 
pecularity  of  organisms  of  this  type  is  that  they  rapidly  acquire  immunity 
to  the  antitoxins  developed  in  the  body  against  them,  and  thus  establish  a 
more  or  less  permanent  residence  in  the  body  constituting  a  chronic  affec- 
tion. The  protozoa  also  rapidly  develops  resistance  to  small  doses  of 
chemical  poisons  introduced  into  the  system  against  them  for  curative 
purposes,  as  malaria  is  cured  by  quinine  in  large  doses. 

Mercury  and  arsenic  are  two  chemical  agents  foimd  to  be  especially 
destructive  to  the  germ  of  syphilis.  It  having  been  foimd  difficult  to 
introduce  enough  mercury  into  the  system  to  destroy  the  germs,  without 
seriously  injuring  the  patient,  attention  was  turned  to  arsenic.  By  ex- 
periments Dr.  Ehrlich  announced  to  the  profession  that  a  combination  of 
arsenic  with  soda  would  prove  effective.  This  he  has  named  Salvarsan, 
or  606. 

Salvarsan  is  a  light-yellowish  powder,  containing  about  thirty-four 
per  cent,  of  arsenic ;  when  dissolved  in  water  forming  strongly  acid  solu- 
tions, on  account  of  this  acid  reaction,  it  must  be  neutralized  before  use. 
The  preparation  is  administered  only  with  great  care  by  a  physician, 
intravenous  or  by  subcutaneous  injection.  Some  observers  have  secured 
similar  results  by  the  use  of  cocodylic  acid,  a  salt  of  the  allotropic  form  of 
arsenic,  by  injections  of  one  or  two  grains.  It  also  appears  that  mercury, 
instead  of  being  contra-indicated,  at  the  same  time  may  aid  in  a  cure. 
It  is  hoped  that  all  that  is  claimed  for  it  will  be  fulfilled,  and  that  hu- 
manity will  be  cured  of  this  so-called  great  pox. 


SPERMATORRHCEA  OR  INVOLUNTARY  EMISSIONS. 

As  an  appendix  to  the  unsavory  subjects  discussed  in  this  chapter,  a 
few  remarks  upon  spermatorrhoea  and  its  usual  cause  are  appropriate  here. 
It  would  be  impossible  to  estimate,  with  any  approach  to  accuracy,  the  vast 
amount  of  anxiety  and  mental  suffering  needlessly  endured  in  our  com- 
munity in  regard  to  this  disease.     It  is  sad  to  think  of  the  many  men. 


llsrVOLTJNTAEY  EMISSIONS.  62f 

young,  middle-aged  and  those  who  are  still  young  in  age  and  strength,  who 
suffer  from  one  or  more  of  the  above  conditions,  robbing  them  of  all  that 
is  precious  and  so  important  to  them.  Many  men  are  mere  pigmies  of 
what  they  should  be.  Because  of  this  decline  they  are  backward  and  sensi- 
tive, unaggressive  in  their  business,  easily  discouraged,  weak  and  nervous, 
instead  of  being  strong  and  vigorous. 

The  Disease  and  Results. — That  the  disease  called  spermatorrhoea  ex- 
ists, and  in  rare  cases  does  result  in  the  utter  wreck  of  mind  and  body, 
which  is  painted  by  these  designing  quacks  in  such  sombre  colors,  cannot 
be  denied,  but  that  nineteen  out  of  every  twenty  young  men  who  have  be- 
come alarmed  by  the  occasional  or  even  frequent  occurrence  during  sleep 
of  what  they  have  learned  to  control  whilst  awake,  have  no  real  ground 
for  their  agonizing  fears  is  equally  indisputable. 

Causes. — The  usual  cause  of  spermatorrhoea,  of  course,  cannot  be 
freely  discussed  in  a  popular  work  like  this,  and  yet  enough  may  be  ex- 
pressed in  veiled  language,  the  meaning  of  which  will  be  only  or  chiefly 
comprehended  by  those  who  need  the  lessons  inculcated,  to  accomplish, 
it  is  hoped,  much  good.  Many  young  persons  of  both  sexes,  after  beingj 
made  aware  of  the  danger  in  which  they  were  becoming  involved  through 
evil  examples,  perhaps,  of  school  associates,  have  earnestly  tried  to  escape 
the  thraldom  of  bad  habits  or  early  indiscretions. 

Treatment  by  Will  Power — Some  of  those  who  have  succeeded,  by 
the  exercise  of  a  resolution,  and  strength  of  will,  for  which  they  deserve 
great  credit,  have  overcome  their  enemy,  but  are  yet  haunted  with  the 
fear  that  they  have  been  irreparably  injured  in  the  struggle.  This  fear 
is  entirely  unfounded,  as  time  will  infallibly  prove. 

Treatment  by  Exercise  and  Nutrition.— A  second  and  larger  class  are 
still  discouraged  by  frequently  recurring  evidence  that  they  are  not  in  a 
natural  and  healthy  condition,  and  some  may  even  be  so  disheartened  as 
to  feel  almost  hopeless.  For  such  plenty  of  exercise  in  the  open  air,  good 
nutritious  food,  chiefly  vegetable,  occupation  of  the  mind  in  some  study  or 
suitable  recreation,  and  the  proper  medical  treatment,  can  with  a  con- 
tinued exercise  of  the  will  power  during  the  waking  hours  speedily  ac- 
complish a  cure. 

Treatment  by  Hygiene  and  Medicine. — To  a  third  class,  who  find  them- 
selves still  unable  to  overcome  temptation,  much  aid  will  be  afforded  by 
adopting  the  plan  of  hygienic  and  medical  treatment  hereunder  indicated, 
and  by  diminishing,  as  the  drugs  mentioned  can  do,  the  force  of  the  im- 
pulse itself,  they  may  so  reduce  its  power  that  a  little  additional  resolu- 


628  DISEASES    OF    THE   UEINAKT    SYSTEM. 

tion  will  suffice  to  achieve  a  victory.  In  this  struggle  they  may  find  some 
support  in  the  grand  old  maxim,  "lie  that  ruleth  Ids  o%\ti  spirit  is  greater 
than  he  who  taketh  a  city."  Among  the  best  remedies  for  this  condition  is 
the  piU  cann-aven.     This  should  be  taken  for  some  time. 

mPOTENCY  IN  MALES  AND  FEMALES. 

Impotence  means  a  lack  of  ability  to  properly  perform  the  sexual 
act.     It  may  be  partial  or  complete. 

In  females  it  may  be  due  to  faults  in  the  ovaries,  absence  of  perfect 
development,  displacements,  inflammations  or  degenerations,  faults  in  the 
oviducts  or  fallopian  tubes,  faults  in  the  uterus,  faults  in  external  organs, 
etc.  Morbid  conditions  of  the  vagina  should  be  corrected  and  morbid 
conditions  of  the  "womb  overcome.  Hot  injections  and  hot  baths  are  of 
great  service  where  inflammation  is  a  cause. 

In  males  impotency  may  be  due  to  advanced  age,  disease  of  testicles, 
absent  or  defunct  erection,  spinal  irritation,  malformation,  non-develop- 
ment of  the  organs,  early  abuses,  loss  of  will  power,  sexual  excesses, 
gonorrhcea,  gleet,  alcoholism,  etc. 

In  all  cases,  whether  male  or  female  examination  should  be  made  by 
a  competent  physician  (avoid  quacks)  in  order  to  determine  the  actual 
cause.  The  general  health  should  be  looked  after  and  a  tonic  treatment 
should  be  carried  out,  among  the  remedies  used  being  damiana,  strychnine, 
phosphorus,  etc.  A  good  pill  is  the  neuro-tonal  or  compound  damiana.  A 
direct  and  useful  remedy  is  cantharides  in  three-drop  to  ten-drop  doses 
three  times  a  day.  Dilute  phosphoric  acid,  phosphate  of  iron  and  ergot 
of  rye  are  also  valuable.  These  remedies  may  be  used  by  either  sex  and 
should  be  continued  for  some  time. 

Apparent  impotency  in  the  male  is  frequently  due  to  lack  of  confi- 
dence. A  newly-married  person  who  finds  difficulty  in  this  way  should 
not  become  disheartened.  A  full  imderstanding  of  conditions  and  a 
masterful  reassertion  of  confidence  will  prove  of  more  avail  than  medicines. 


PART  IX  OF  BOOK  IV 

Treats  of  the  Urine  in  health  and  disease  and  gives 
a  series  of  tests  for  urine  which  may  be  used  in  the 
home. 


Acidity  of  Urine,  Test  for 634 

Alkalinity  of  Urine,  Test  for  634 

Gravometer    634 

Hydrometer    634 

Specific  Gravity  of  Urine,  Test  for... 634 

Table  of  Urinary  Constituents    633 

Tests  of  Urine   634 

Urine,  The   631 

Acid,  Test  for  634 

Alkaline,    Test    for    634 

Amount  of    631 

Color  of   631 


Consistency  of  632 

Constituents  of   633 

Density    of .633 

Examination  of   634 

Reaction  of 633 

Specific  Gravity  of  632 

Table   of   Constituents    633 

Tests  for  634 

Test  for  Specific  Gravity   634 

Transparency  of   632. 

Urinometer 634 


Home  Tests   for  Urine    (full  page  in 

colors) 634 


ILLUSTRATIONS 

The  Urinometer 


•634 


629 


CURATIVE   MEDICINE 


PAET  IX. 
URINE  IN  HEALTH  AND  DISEASE. 


As  a  rule,  in  chronic  diseases  one  of  the  first  manifestations  is  a 
change  in  the  urine,  sometimes  noticeable  by  appearance,  but  in  other 
eases  only  discernible  by  careful  examination.  We  shall  first  consider 
urine  in  normal  condition  and  then  the  effects  upon  the  same  when  the 
body  Is  diseased. 

Amount. — The  normal  quantity  of  urine  varies  from  2|  to  3-|  pints 
in  the  twenty-four  hours,  the  quantity  being  greater  with  men  than  with 
women.  It  is  decreased  by  free  perspiration  and  increased  by  chilling  of 
the  skin.  The  quantity  of  fluids  taken  is  of  course  a  factor.  Different 
diseases  affect  the  quantity  in  different  ways,  causing  an  increase  in 
diabetes,  in  some  nei"vous  diseases,  like  hysteria  and  convulsions,  also 
in  apoplexy,  convalescence  from  acute  and  inflammatory  diseases  and 
in  enlargement  of  the  heart.  It  is  decreased  by  heat,  in  fevers,  shock, 
stoppage  due  to  heart  disease,  acute  congestion  of  the  kidneys,  in  diseases 
accompanied  by  purging  and  vomiting.  In  all  forms  of  Bright's  disease 
(with  the  exception  of  chronic  diffuse  and  interstitial  kidney  trouble) 
and  in  all  diseases  before  death,  the  decrease  is  due  to  obstruction  in  the 
bladder  or  the  urethra. 

Color — The  normal  color  is  light  amber,  which  deepens  in  shade  if 
the  quantity  voided  be  decreased,  and  vice  versa.  The  quantity  of  fluids 
drunk  and  the  extent  of  perspiration  also  have  effect  on  color.  In  disease 
it  will  be  found  pale,  in  diabetes,  hysteria,  interstitial  nephritis  and  like 
disorders,  the  specific  gravity  usually  remaining  at  or  near  normal  with 
the  exception  of  diabetes,  whore  the  specific  gravity  is  very  high,  owing 
to  the  presence  of  sugar.  It  is  high-colored  in  most  other  diseases  and  in 
acute  fevers  and  inflammation.     Heddish  color  indicates  the  presence  of 

631 


632  THE   tJBINE   IX    llEAiTlI    AXD    DISEASE. 

abnormal  coloring  matter,  usnallj  blood.  A  dark  brown  color  may  bs  a 
sign  of  hemorrhage  of  the  kidney.  Urine  which  turns  greenish  on  stand- 
ing contains  bile  pigments.  In  cancer  the  iirine  becomes  almost  black 
on  standing,  in  typhus  and  cholera,  blue.  Both  diet  and  drugs  have 
effect  on  color.  After  taking  rhubarb  or  senna  the  urine  is  apt  to  be 
brownish,  santonin  produces  yellow  and  methyl  causes  a  bluish  color. 

Odor. — There  is  a  peculiar  aromatic  or  urinous  odor  from  normal 
urine,  which  becomes  putrid  and  ammoniacal  on  standing.  Fresh  urine 
which  has  these  latter  characteristics  indicates  bladder  trouble ;  a  fecal 
odor  indicates  a  fistule  between  the  urethi'a  and  rectum.  The  odor  may 
be  changed  by  vegetables  or  drugs,  turpentine  giving  the  odor  of  violets, 
asparagus,  turnips,  cubebs,  copaiba,  sandalwood,  etc.,  each  producing 
their  o^^^l  peculiar  odor.  In  diabetes  the  urine  smells  sweet.  A  par- 
ticularly foul  smell,  as  of  sulphur,  is  given  off  when  there  is  pus  in  the 
bladder. 

Consistency. — The  normal  consistency  is  that  of  water,  but  it  becomes 
thick  and  sometimes  stringy  on  standing,  more  particularly  after  it  has 
become  alkaline.  Where  there  is  much  sugar  or  albumin  there  is  a  ten- 
dency to  frothincss. 

Transparency — Freshly  passed  urine  in  normal  state  is  always  clear, 
but  after  standing  a  faint  cloud  of  excrete  matter  floats  near  the  center 
and  eventually  settles  to  the  bottom.  This  is  increased  in  cystitis,  pros- 
tatitis, urethritis  and  other  catarrhal  conditions  of  the  urethral  tract. 
It  is  more  pronounced  in  women  than  in  men.  It  may  be  distinguished 
from  other  cloudy  substances  by  its  tendency  to  float  in  the  center  and 
its  preciijitation  by  an  excess  of  acetic  acid.  Bacteria,  phosphates,  or 
jnis  cause  turbid  urine.  If  due  to  bacteria,  the  turbidity  is  not  cleared 
with  acetic  acid,  whereas  if  due  to  phosi^hates,  it  Avill  be  cleared  by  a  few 
drops  of  acetic  acid.  Urates  cause  a  deposit  to  settle  quickly,  pus  pro- 
duces an  opaque  color  which  in  a  few  minutes  settles  to  the  bottom. 

Specific  Gravity — The  noi-mal  specific  gravity  varies  from  1.010  to 
1.025.  It  is  low  when  an  increased  quantity  is  passed  and  high  when  the 
quantity  is  diminished.  Determination  of  specific  gravity  should  be  made 
by  taking  a  small  quantity  of  the  total  passed  in  twenty-four  hours,  care 
being  taken  that  the  vesel  is  absolutely  clean  before  starting  and  that  it  is 
kept  covered  between  the  urinations.  The  specific  gravity  is  increased 
at  the  beginning  of  acute  fevers,  after  severe  operations,  at  the  commence- 
ment of  acute  Bright's  disease  and  when  the  urine  contains  blood.  It  is 
exceptionally  high  in  diabetes,  sometimes  reaching  as  high  as  1.050.     It 


EXAMINATION    OF    UEINE. 


633 


is  diminished  in  Bright's  disease  (excepting  the  first  stage  of  acute  above 
referred  to),  in  all  forms  of  impaired  circulation  due  to  heart  disease,  iu 
hysteria  and  iu  chronic  interstitial  nephritis. 

Reaction — The  normal  reaction  is  slightly  acid,  excepting  after  meals, 
when  it  may  be  neutral  or  even  alkaline.  Acidity  is  increased  by  a  red- 
meat  diet  and  diminished  by  obstruction  aud  iuflammatiou  of  the  urinary 
tract. 

Constituents. — The  most  important  organic  aud  inorganic  solid  con- 
stituents held  iu  solution  are:  Urea,  from  308  to  617  gi-ains  daily;  wic 
acid,  from  6  to  12  grains;  urates  of  sodium,  ammonium,  potassium,  cal- 
cium and  magnesium,,  from  9  to  14  grains;  pliosphates  of  sodium,  etc., 
from  12  to  45  grains,  and  chlorides  of  sodium;  etc.,  from  154  to  247 
grains  daily.  The  following  table  shows  specifically  the  amount  of  solid 
matter  contained  in  1000  grains  of  urine  of  different  densities. 


Specific 
Gravity. 

Solids. 

Water. 

Specific 
Gravity. 

Solids. 

Water. 

Specific 
Gravity. 

Solids. 

Water. 

[Specific 
Gravity. 

Solids. 

Water. 

1001 

2  3.3 

997.67 

1011 

25.63 

974.37 

1021 

48.93 

951.07 

1031 

72.23 

927.77 

1002 

4.66 

995.34 

1012 

27.96 

972.04 

1022 

51.26 

948.74 

1032 

74.56 

925.44 

1003 

6.99 

993.01 

1013 

30.29 

969.71 

1023 

53.59 

946.41 

1033 

76.89 

923.11 

1004 

9.32 

990.68 

1014 

32.62 

967.38 

1024 

5.5.92 

944.18 

1034 

79.22 

920.78 

1005 

n.65 

998.  .35 

1015 

34.95 

965.05 

1025 

58.25 

941.75 

1035 

81.55 

918.45 

1006 

13.98 

986.02 

1016 

37.23 

962.72 

1026 

60.50 

939.42 

1036 

83.88 

916.12 

1007 

16.31 

98.3.69 

1017 

39.61 

960.39 

1027 

62.91 

937.09 

1037 

86.21 

913.79 

1008 

18.64 

981.36 

1018 

41.94 

658.06 

1028 

65.24 

934.76 

1038 

88.54 

911.46 

1009 

20.97 

979.03 

1019 

44.27 

955.73 

1029 

67.57 

932.43 

1039 

91.87 

909.13 

1010 

23.30 

976.70 

1020 

46.60 

953.40 

1030 

69.99 

930.40 

1040 

93.20 

906.80 

The  manner  of  using  the  above  table  is  as  follows:  The  density  of 
urine  passed  in  twenty-four  hours  having  been  ascertained,  as  hereafter 
explained  under  the  caption  "Examination  of  Urine,"  a  glance  at  the 
table  will  show  the  proportion  of  solid  matter  and  water  in  1000  grains 
of  the  urine,  then  taking  the  weight  of  tlic  whole  quantity  of  urine  passed 
in  the  twenty-four  hours,  the  solids  drained  off  by  the  kidneys  may  be 
determined  by  the  simple  rule  of  proportion. 

Urine  passed  shortly  after  drinking  excessively  is  pale  and  has  a 
low  specific  gi-avity,  varying  from  1.003  to  1.009.  That  passed  soon 
after  the  digestion  of  a  full  meal  has  a  specific  gravity  of  from  1.020  to 
1.030.  The  best  specimen  of  average  density  and  nature  of  healthy 
urine  is  obtained  in  the  morning  before  eating  or  drinking,  and  iu  perfect 
health  should  range  from  1.015  to  1.025. 


634 


TJIE    URINE    IN    HEALTH    AND    DISEASE. 


EXAMINATION  OF  URINE. 


^0n 


M 


ii 


tA 


m 


The 
Urinometer. 


Different  tests  of  urine  are  made  for  the  discovery 
of  different  constituents,  but  in  respect  of  all  tests  it 
is  first  necessary  to  determine  whether  the  urine  is  acid 
or  alkaline  and  to  ascertain  the  specific  gravity. 

Acidity  or  Alkalinity — Dip  a  piece  of  blue  litmus 
paper  in  the  urine  and  if  on  removing  the  color  of  the 
paper  is  changed  to  red  or  reddish-brown  it  will  indi- 
cate that  the  urine  is  acid.  If  there  be  no  change  in 
the  color  of  the  paper  then  use  yellow  turmeric  or  red- 
dened litmus  paper.  If  the  color  still  remains  unaltered 
tlie  urine  is  neutral,  that  is,  it  is  neither  acid  nor  alka- 
line, but  if  the  yellow  turmeric  becomes  brown,  or  the 
reddened  litmus  changes  to  blue,  the  urine  is  alkaline. 

Specific  Gravity. — For  this  purpose  a  urinometer 
should  be  obtained  (see  accompanying  cut).  It  is  also 
known  by  the  names  of  hydrometer  and  gravometer 
and  can  be  obtained  at  all  surgical  instrument  houses 
and  most  drug  stores.  It  is  graduated  in  such  manner 
as  to  show  the  different  degrees  of  specific  gravity  and 
is  utilized  in  connection  with  a  small  glass  tube,  also 
graduated,  into  which  the  urine  is  poured.  When 
placed  in  still  water  the  urinometer  will  sink  to  a  cer- 
tain point,  and  as  all  solids  immersed  in  fluid  displace 
a  bulk  equal  to  themselves,  it  follows  that  the  urino- 
meter will  not  sink  as  deep  in  a  fluid  which  is  denser 
than  water.  The  instrument  having  been  immersed  in 
the  tube  of  urine  and  come  to  rest,  the  number  on  the 
graduated  scale  which  stands  at  the  sni'face  of  the 
licpiid  plus  1.000  will  represent  the  specific  gravity  of 
the  urine.  For  instance,  if  the  number  at  the  surface 
be  7,  the  specific  gravity  will  be  1.007;  if  it  is  28,  it 
will  be  1.028. 


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How  to  Examine  the  Urine 


Specific  Gravity — This  should  be  done  vrith  a  Uriuometer.  In  health 
it  varies  from  1.012  to  1.025.  In  disease  from  1.002  to  1.040.  Deter- 
mination shonld  he  made  from  21  lionrs'  ■iirino. 

Reaction. — Xormal  iirine  is  slightly  acid,  and  the  test  can  be  made 
Avith  Litmus  paper.     If  acid  it  turns  the  blue  paper  red  or  pink. 

Transparency. — Xormal  urine  freshly  passed  is  clear,  but  on  standing 
it  becomes  cloudy  and  finally  there  is  a  precipitate. 

Consistency Xormal  is  practically  the  same  as  -^vater ;  becomes  thick 

and  stringy  on  standing. 

Odor. — Xormal  urine  has  an  aromatic  or  urinous  odor ;  on  standing 
becomes  amnioniacal. 

Albumen. — Test :  Boil  the  urine  and  add  a  small  quantity  of  nitric 
acid.     If  there  is  a  precipitate  and  it  does  not  dissolve  albumen  is  present. 

Sugar. — Test :  Take  a  teaspoouf  ul  of  Fehling's  or  Haines'  Solution ; 
boil  and  add  a  few  drops  of  urine.  If  sugar  is  present  there  will  be  a 
reddish  precipitate.     If  no  sugar  it  will  remain  clear. 

Indican — Test :  To  a  teaspoonful  of  hydrochloric  acid  add  one  drop 
of  nitric  and  fifteen  drops  of  urine  and  stir.  In  five  to  twenty  minutes  an 
amethyst  color  denotes  normal  amount  present;  a  deep  violet  shows  more 
than  the  normal  amount. 


PART  X  OF  BOOK  IV 

Describes  the  many  diseases  which  are  peculiar  to 
women,  their  causes,  diagnoses,  symptoms  and  various 
modes  of  treatment. 


Abdomen,    Changes    in    689 

Abortion    678,   681 

Criminal     682 

Dangers  of  682 

Divisions   of    681 

Evil  of   6-8 

Treatment  of   678,  684 

Abscess  of  Breast  675 

Afterbirth,  Expelling  the   699 

Amenorrhea    640 

Atresia  of  the  Vagina 657 

Baby's  First  Bath   701 

Putting  to  Breast    70S 

Suckling,  The   704 

Biith  of  Child 695 

Presentation  of  Child    695 

Bladder,  Diseases  of  673 

Inflammation  of   673 

Irritability   of    673 

In  Pregnancy   694 

Stone   in    674 

Bleeding  of  the  Vulva   654 

Bottle,  Cleanliness  of  7o6 

Breast,  Abscess  of  675 

Cancer  of   676 

Diseases  of 675 

Inflammation  of 67s 

Milk   704 

Putting  Baby  to   70S 

Tumors  of 676 

Bringing  up  the  Infant  by  Hand. .  .  .705 

Bulb  Syringe   647 

Buttock  Presentation  in  Childbirth. 696 

Cachexia  in  Cancer  of  Womb   663 

Cancer  of  the  Breast   676 

Cancer  of  the  Vagina  658 

Cancer  of  the  Womb   662 

Cachexia  in   663 

Hemorrhage  in  662 

Hemorrhage,  Checking  of   664 

03 


Injections  for  664 

Morphine,  Use  of   663 

Visceral   Disorders    663 

Carbuncle,   Urethral    657 

Care  of  the  Skin 677 

Cessation  of  Menses  640 

Change   of   Life    679 

Child,  Attending  the  699 

Child-bed  Fever   702 

Child-birth     69s 

Buttock  Presentation   696 

Mother's  Dress  in  696 

Presentation  of  Child 695 

Should  Child  Not  Cry  700 

Shoulder  Presentation 696 

Wrong  Presentations  701 

Child  Blemishes   Produced  in   Preg- 
nancy     693 

Child,  Delivery  of  698 

Child,  Presentation  of  at  Birth 69s 

Child,  Weaning  the  706 

Cleanliness  of  Nursing  Bottle 706 

Closet,  the  Outdoor  650 

Coccygodynia   657 

Conception    C79,   685 

Conception  of  Twins   686 

Constipation    648 

Causes  of  648 

Diet  in   651 

in   Pregnancy   694 

Nausea    649 

Poisoning   in    649 

Prescriptions  for   652 

Treatment    of    651 

Contraction  of  Womb   699 

Contraction  of  Vagina  656 

Convulsions,    Puerpeial     703 

Crabs 656 

Cracked  Nipples  702 

Criminal  Abortions 681 

6 


636 


INDEX    TO    PART    X    OF    BOOK    IT. 


Cystic  Tumors  of  the  Ovary   669 

Cystitis    673 

Delayed   Menstruation    641 

Delivery  of  Child  698 

Dilution  of  Milk  706 

Diseases  of  the  Bladder   673 

and  Marriage    678 

of  External   Genital   Organs. ..  .653 

of  the  Female  Breast  67s 

of  the   Ovaries    667 

of  the  Oviducts 667 

of  the  Uterus 659 

of  the  Vagina 657 

of  the  Womb    659 

of  Women,  List  of   639 

Disorders  of  Menstruation   640 

Displacement  of  Ovary   669 

of  Womb   664 

Douche,  The  647 

Douching,  Position  in    648 

Dressing,  Mode  of  677 

the  Navel    701 

Duration  of  Labor 695 

Dysmenorrhea    641 

Ectopic  Pregnancy   686 

Endometritis    659 

Enlarged  Veins  in  Pregnancy 694 

Exercise  in  Pregnancy 693 

Excessive   Menstruation    643 

Meaning  of 643 

Plugging  the  Vagina  in 644 

Removal  of  Tumors   644 

Treatment  644 

Expelling  the  Afterbirth  699 

Extra  Uterine  Pregnancy   707 

Symptoms  of 707 

Treatment  of  "07 

Falling  of  Womb   666 

Fetid  Dis(?harge  in  Leucorrhea 646 

Fever,  Child-bed   702 

Puerperal   702 

Fibrous  Tumors  of  Uterus 65o 

Treatment  of 660 

Fibrous  Tumors  of  Womb  660 

First  Stage  in  Labor  697 

Flooding  in  Childbirth  700 

Food  During  Pregnancy   692 

Proper   Kinds  of   (>^7 

Fountain  Syringe 647 

Genital  Organs,  External   653 

Gonorrhea    671 


Gonorrhea,  Diseases  Induced  by 672 

Treatment  of   672 

Hematoma  of  the  Vulva  6.54 

Hyperemesis  of  Pregnancy  694 

Impregnation,  How  it  Occurs 686 

Infant,  Bringing  Up  by  Hand    705 

Management  of 704 

Inflammation  of  the  Bladder 673 

of  the  Breast  67s 

of  Oviducts   667 

of  the  Vagina   658 

of  Vulva  653 

of  Walls  of  Womb  660 

Injection,  Vaginal   647 

Labor    694 

After-management    701 

Birth  Presentation   695 

Buttock  Presentation   696 

Duration  of  695 

Duration  of  Second  Stage   695 

First  Child   695 

First  Stage   697 

Length  of  First  Stage 697 

Mother's  Dress  in   696 

Pains  of  First  Stage   697 

Period  of 697 

Premature  695 

Preparations  for  696 

Second  Stage  697 

Shoulder  Presentation 696 

Stages  of  696 

Third  Stage   698 

Lacerations  of  the  Perineum 670 

Length  of  First  Stage  in  Labor  ....697 

Leucorrhea   645 

Fetid  Discharge   646 

Injection  for   646 

Treatment  of 64s 

Lining  Membrane  of  Womb   659 

Malignant  Tumors  of  Vagina   658 

]\Iammary  Gland   689,  690 

Mammitis    675 

Management  of  Infant 704 

Mania,  Puerperal   703 

Marriage  with  Disease  678 

Mastitis    675 

]\Ienopause    679 

Menorrhagia    643 

Menses,   Cessation  of   640 

Menstrual  Period  678 

Menstruation    639 


INDEX    TO    I'AET    X    OF    BOOK    IV. 


637 


Beginning  of  639 

Delayed    641 

Disorders  of  640 

Excessive    643 

Frequency  of 640 

Painful 641 

Parent's  Dnty  in 639 

Suppressed    640 

Treatment  641 

When  to  Avoid  Medicines  in. ...641 

Metritis     660 

Metrorrhagia    C43 

Midwife,  Duty  of  6g8 

Milk-leg   703 

Milk,  Dilution  of  706 

Mother's    704 

Testing  the 705 

Miscarriage     681 

Morning  Sickness    688,  693 

Mother,   Attention    to,    after    Child- 
birth   700 

Avoid  Excitement   705 

Dress  in  Childbirth  696 

Milk   704 

Nausea  in  Constipation 649 

Nausea  in  Menstruation   642 

Navel,  Dressing  the 701 

Nipples,  Cracked   702 

Sore   702 

Preparation  of 697 

Nurse,  The  Wet  70S 

Nursing  Bottle,  Cleanliness  ot 706 

Nursing  Mothers    to  Avoid   Excite- 
ment     705 

Nursing,  Time  for  705 

Orgasm,  Lack  of  687 

Ovaries 667 

Diseases  of 667 

Treatment  of  668 

Ovaritis    667 

Ovary   690 

Displacement  of 669 

Prolapsus   669 

Tumor  of  669 

Overwork    677 

Oviducts,  The   667 

Diseases  of 667 

Inflammation  of  667 

Ovule,  The   685 

Painful  Menstruation   641 

Bearing  Down  Pains   642 


Meaning  of 641 

Nausea   642 

Purgation  in  643 

Treatment 642 

Pains  in  Labor 697 

Parturition    693 

Perineum  670 

Lacerations  of  the   670 

Period  of  Labor  697 

Plugging  the  Vagina 644 

Poisoning  in  Constipation   649 

Polypus   Tumor  of  Womb    661 

Pregnancy 688 

Care  During 692 

Child  Blemishes  in 693 

Condition  of  Bladder  in  694 

Constipation  in  694 

Duration  of 68g 

Ectopic    686 

Enlarged  Veins  in   694 

Exercise  in  693 

Extra  LTterine   707 

First  Indication  of 688 

Food  During  692 

Hyperemesis  of 694 

Morning  Sickness  in  _.  .688 

Quickening  Period 689 

Toothache  in' 694 

Uterine 688 

Vomiting   in    693 

Pregnancy  Table   692 

Premature    Labor    695 

Preparing  the  Nipples   697 

Prevention    of    Flooding    in     Child- 
birth     700 

Prolapsus  of  Ovary   66g 

of  Womb    666 

Pruritus   Vulva    654 

Puberty   in   Women    639 

Puerperal   Conditions   702 

Convulsions    703 

Fever    '.....  702 

Mania    703 

Pyosalpinx    668 

Quickening   Period    in    Pregnancy .  .689 

Removal  of  Tumors   644 

Salpingitis     667 

Scabies    655 

Second  Stage  in  Labor   697 

Shoulder      Presentation      in      Child- 
birth     696 


638 


INDEX    TO   PART   X   OF    BOOK   IV. 


Skin,  Care  of  677 

Skin  Diseases  of  the  Vulva  655 

Sore  Nipples    702 

Spermatozoids     686 

Movement  of   686 

Sterility 687 

Stone  in  Bladder  674 

Suckling  the  Baby  704 

Suppressed  Menstruation   640 

Syringes     647 

Bulb    647 

Fountain    647 

Table,   Pregnancy    693 

Temperature  of  Douches   648 

Testing  the  IMilk  70S 

Third  Stage  in  Labor 6g8 

Tight   Lacing    678 

Time  for  Niirsing  705 

Toothache  in  Pregnancy  694 

Treating  the  Womb   699 

Tumors,  Cystic,  of  the  Ovary 66g 

Fibrous,   of   Uterus    660 

of  the   Ovary    669 

of  the  Vagina    658 

of  the  Vulva   655 

Polypus,  of  Womb   661 

Removal   of    644 

Twins,   Conception  of  686 

Ulceration  of  Womb   661 

Menstruation   in    661 

Treatment   of    661 

Urethral  Carbuncle   657 

Uterine  Pregnancy   688 

Extra    707 

Uteriis    659 

Cancer  of 662 

Diseases   of    659 

Fibrous  Tumors  of 660 

Inflammation  of  659 

Lining  Membrane  of   659 

Polypus  Tumor  of 66t 

Ulceration  of 66i 

Vagina 657 


Atresia  of  the   657 

Cancer  of 658 

Contraction   of 656 

Diseases   of    657 

Inflammation   of    658 

Malignant   Tumors  of   658 

Plugging  the   644 

Vaginal   Injection    647 

Proper  Way  to  Take    647 

Vaginismus    656 

Vaginitis     658 

Veins,  Enlarged  in  Pregnancy  694 

Visceral  Disorders  of  Womb   663 

Vomiting  in  Pregnancy 693 

Vulva,  Tlie  653 

Bleeding  of   654 

Inflammation  of   653 

Itching  of    654 

Skin  Diseases  of  655 

Tumors  of  the   655 

Vulvitis    653 

Treatment  of 653 

Weaning  the  Child   706 

Wet  Nurse,  The   705 

Whites    64s 

Womb   659 

Backward  Displacements    665 

Cancer  of  662 

Contracting  the    699 

Diseases  of  659 

Displacements  of   664 

Falling  of  666 

Fibrous  Tumors  of  660 

Forward   Displacements   of    ...  .664 

Inflammation  of  659 

Lining  Membrane  of   659 

Polypus  Tumor  of  661 

Prolapsus  of   666 

Treating  the    699 

Ulceration  of   661 

Vv^omen,  Interesting  Facts  Concern- 
ing     677 

Wrong  Presentations  in  Childbirth. 701 


ILLUSTRATION 

Ovary  and  Mammary  Gland   691 

Urinary    and    Generative    Organs.. .640 


CURATIVE  MEDICINE 


PART  X. 
DISEASES  PECULIAR  TO  WOMEN 


List  of  Diseases. — The  diseases  peculiar  to  the  female  sex  comprise 
those  of  the  uterus  (womb),  ovaries  and  their  appendages,  the  vagina, 
external  generative  organs  and  mammary  glands  (breasts). 

Divisions  of  Woman's  Life. — The  life  of  a  woman  may  be  divided 
into  five  periods.  They  are  infancy,  puberty,  maturity,  the  menopause 
and  senility. 

Period  of  Puberty. — Puberty  is  the  jjcriod  in  which  the  child  becomes 
the  woman,  this  is  the  period  when  she  begins  to  menstruate.  It  is  the 
time  when  the  breasts  begin  to  assimie  a  rounded  fonn,  her  general 
contour  becomes  sharpened,  and  her  generative  organs  have  reached  their 
full  development.  jMaturity  extends  from  puberty  to  the  menopause,  and 
is  the  period  during  which  women  bear  children. 

MENSTRUATION. 

A  Mother's  Duty. — Menstruation  or  the  monthly  flow  is  characterized 
by  a  bloody  discharge  from  the  womb,  and  occurs  at  regular  periods, 
usually  every  twenty-eight  to  thirty  days.  It  is  the  duty  of  every  mother 
to  explain  to  her  female  offspring  this  condition  of  affairs,  detailing  when 
it  occurs,  how  often  to  expect  it,  and  the  use  of  the  napkin  during  this 
period.  Too  many  mothers,  on  account  of  a  mock  modesty,  allow  their 
children  to  pass  through  the  establishment  of  this  function  in  total  ignor- 
ance.    Such  practice,  however,  should  be  condemned. 

Beginning  of  Menstruation. — I  have  often  seen  children  run  to  their 
mother  when  the  first  drop  of  blood  appeared,  frightened  beyond  descrip- 
tion.    The  first  flow  usually  appears  between  the  ages  of  twelve  to  four- 

(639) 


Q4Q  DISEASES    PECDLIAR   TO    WOMEN. 

teen.     In  the  torrid  zone  it  appears  two  or  three  years  earlier,  thus  these 
children  are  capable  of  child  bearing  at  so  early  a  period. 

Frequency  of  Menstruation. — Every  woman  is  a  law  unto  herself.  As 
before  stated,  menstruation  usually  appears  every  twenty-eight  to  thirty 
days ;  some  women,  however,  menstruate  every  four  to  six  weeks  and 
are  in  perfect  health.  A  napkin  should  always  be  worn  during  the  flow; 
surprising  as  it  may  seem,  many  fail  to  do  so. 

DISORDERS  OF  MENSTRUATION'. 

Suppressed  Menstruation  (Amenorrhea) . — This  is  a  term  applied  to  the 
absence  of  menstruation,  between  jiuberty  and  the  menopause. 

Causes. — Pregnancy,  and  when  nursing;  anemia  (impoverish-ment  of 
the  blood  (is  a  very  frequent  cause;  consumption,  debilitating  diseases, 
non-development  of  the  generative  organs;  obesity  and  after  the  ovaries 
tave  been  removed. 

Symptoms — Amenorrhea  may  come  on  suddenly  or  be  of  gradual 
development.  Tlie  former  variety  is  often  the  result  of  some  violent 
excitement,  fright  or  mental  shock  due  to  the  setting  in  of  some  fever  or 
other  acute  disease,  or  to  that  common  and  very  dangerous  cause,  espe- 
cially in  young  girls,  imprudent  exposure  to  cold  or  wet  during  the 
monthly  flow. 

Symptoms  in  Anemic  Persons — If  due  to  anemia  the  patient  has  a 
pallor,  and  the  margins  of  the  lips  will  be  pale,  she  will  look  ''bleached 
out,"  shortness  of  breath,  palpitation  of  the  heart,  swelling  of  the  feet 
and  ankles,  headache  and  constipation. 

Symptoms  in  Consumptives. — If  due  to  consumption,  cough  and  night 
sweats  will  be  present,  accompanied  by  marked  emaciation  (wasting 
away).  When  amenorrhea  comes  on  gradually  it  is  apt  to  indicate  some 
serious  chronic  disease,  which  should  be  immediately  investigated  and 
attended  to  by  a  skillful  physician. 

Cessation  of  Menses — When  the  cessation  of  the  menses  is  part  of 
such  a  severe  malady  as  consumption  or  Bright's  disease,  it  often  appears 
to  be  only  nature's  method  of  economizing  the  failing  strength  of  the 
invalid,  so  that  any  interference  would  be  likely  to  prove  positively 
hurtful.  On  the  other  hand,  the  natural  reappearance  of  the  menses 
after  a  stoppage  in  the  course  of  a  chronic  malady  may  be  welcomed  as  a 
favornblo  indication  of  a  tendency  toward  improvement. 

Symptoms  Attending  Stopped  Menses. — The  constitutional  disturbanoe 


Mons  Veneris. 

Pubic   Bone. 

Clitoris. 

Urelhra. 

Bladder. 

Urachus. 

Ovary. 

Broad   Lisrament. 


9 

10 

II 

12 

13 
14 
15 
1 6, 


Womb. 

Neck  of  Womb. 

Vagina. 

Rectum. 

Anus. 

Rectum  covered  by  Peritoneum. 

Spinal  column. 

Spinal  cord. 


The  abo\e  outline  drawing  will  sho 
and  Generative  Organs  of  Women,  all 
pelvis.     This  is  shown  by  dividing  the 
above  downward.     The  various  parts  a 
brrs,   so  that  the  position  and  shape  o 


w  the  relative  position  of  the  Urinary 
contained  within  and  surrounding  the 
body  directly  throueh  the  centre  from 
re  plainly  shown  and  tlesisrnated  by  num- 
f  each  organ  can  be  readily  seen. 


PAINFUT-  MENSTEDATION.  641 

'from  abrupt  suppression  of  the  monthly  flow  is  generally  very  great. 
There  is  usually  severe  pain  in  the  region  of  the  womb,  similar  in  char- 
acter to  that  of  colic,  and  hysterical  excitement,  or  even  convulsions, 
and  mania,  may  be  the  direct  effect. 

Treatment. — When  due  to  anemia,  iron  is  the  best  remedy,  given  in 
the  form  of  Blaud's  pill,  one  four  to  five  times  a  day.  When  taking  iron 
it  is  always  a  good  rule  to  take  a  dose  of  epsom  salts  once  a  week,  in  order 
to  counteract  the  constipating  effect  of  the  drug.  Other  remedies  are,  a 
teaspoonful  of  the  elixir  of  quinine,  iron  and  strychnia,  three  to  four  times 
a  day ;  the  pill  of  the  same  ingi'edients,  ono  four  to  five  times  a  day ;  per- 
manganate of  potash,  two  grains  three  times  a  day;  or  the  bin-oxide  of 
manganese,  two  grains  three  to  four  times  a  day. 

When  to  Avoid  Medicines. — The  possibility  that  absence  of  the 
monthly  period  may  be  due  to  pregnancy  should  always  be  borne  in  mind, 
in  which  case  it  would  be  dangerous  and  criminal  to  administer  any  of 
the  usual  remedies  for  restoring  the  flow. 

Treatment  When  Due  to  Cold. — When  due  to  exposure  to  cold  and 
wet  resort  to  hot  mustard  foot  baths  or  hip  baths,  mustard  plasters  to 
the  inside  of  the  thighs,  calves  of  the  legs  and  ankles.  A  hot  sitz  bath 
is  also  worthy  of  trial.  This  consists  of  partially  filling  a  "foot  tub"  with 
hot  water,  allowing  the  patient  to  sit  in  it,  and  covering  her  with  a 
blanket.  She  should  remain  in  the  bath  for  five  to  ten  minutes.  The  but- 
tocks and  thighs  are  then  thoroughly  dried,  and  she  is  j^ut  to  bed.  If  con- 
stipated the  bowels  should  be  regulated.  (See  Constipation.)  Vaginal 
injections  of  hot  water  are  also  to  be  employed.  (See  "How  to  Use  the 
Douche.") 

Treatment  of  Young  Girls. — The  treatment  of  delayed  menstruation 
in  young  girls  who  have  passed  the  age  of  puberty  must  be  on  general 
principles  adapted  to  improving  the  general  health,  imless  there  are  signs 
of  the  menstrual  blood  being  retained  inside  the  womb,  a  dangerous  con- 
ditio"n  which  should  always  be  considered  in  such  instances  and  relieved 
as  early  as  possible  by  a  surgical  operation.  - 

PAINFUL  MENSTRUATION  (DYSMENORRHEA). 

Meaning  of  the  Disease. — By  this  is  meant  painful  menstruation.   The 
pain  may  occur  Ix^fore,  during  or  after  the  flow.     Many  varieties  hava 
been  described,  such  as  the  obstructive,  congestive,  mechanical,  neuralgic, 
and  so  forth,  but  it  is  very  difficult  at  times  to  differentiate  them. 
41 


642  DISEASES   PECUNIAE   TO    WOMEN. 

Causes. — Usually  due  to  tlie  womb  being  out  of  its  normal  position, 
tumors,  aiul  inflammatory  diseases  of  the  womb  and  ovaries. 

Symptoms — A  woman  who  enjoys  health  not  only  menstruates  reg- 
ularly, but  does  so  with  perfect  freedom  from  suffering,  but  unfor- 
tunately there  are  very  few  members  of  the  female  sex  who  pass  through 
the  whole  period  of  their  sexual  vigor  without  being  called  upon  to  en- 
dure more  or  less  frequently  attacks  of  dysmenorrhea. 

Pain  With  the  Flow — Some  women  experience  great  pain  with  each 
flow,  from  the  commencement  of  puberty,  every  month,  until  the  change 
of  life  relieves  them.  With  the  majority,  however,  pain  is  only  the  ex- 
ceptional accompaniment.  "With  some  women  marriage  effects  a  cure, 
whilst  in  others,  especially  when  there  is  sterility,  it  either  aggravates  or 
originates  the  dysmenorrhea.  Under  no  circumstance,  however,  would  a 
physician  advise  a  woman  suffering  with  dysmenorrhea  to  be  married  in 
the  blind  hope  that  it  would  effect  a  cure. 

Bearing-Down  Pains. — ^Bearing-down  pains,  not  severe,  are  often 
present,  accompanied  by  a  sensation  of  weight.  The  pains  as  a  rule  are 
cramp-like,  and  intermittent,  varying  in  severity.  At  times  the  pains  are 
followed  by  the  expulsion  of  blood  clots  which  oftentimes  affords  relief. 
Severe  pains  as  a  rule  necessitate  the  sufferer  going  to  bed,  where  she  may 
have  to  remain  for  several  hours  to  a  day  or  two.  As  a  rule  constipation 
is  present,  again  diarrhoja  may  be  troublesome. 

Nausea. — ISTausea  followed  by  vomiting  adds  to  the  severity  of  the 
attack.  Headache  is  invariably  present.  The  pains  may  extend  from 
the  lower  part  of  the  abdomen  down  both  legs.  Pain  in  the  back  is  often- 
times quite  marked,  the  sensation  being  that  of  the  back  splitting  open. 

Treatment. — The  existence  of  dysmenorrhea  depends  upon  so  many 
conditions  that  the  treatment  employed  in  one  case  will  seldom  relieve 
the  next.  During  the  attack  of  pain,  the  patient  should  take  a  hot  sitz 
bath,  and  if  the  suffering  is  very  severe,  may  have  a  suppository  of  half 
a  gi-ain  of  opium  combined  with  a  quarter  of  a  grain  of  belladonna.  'Un- 
der no  consideration  should  a  hypodermic  injection  of  morphine  be  given, 
without  a  physician's  advice.  Again,  a  sitz  bath  may  be  given,  followed 
by  a  turpentine  stupe,  and  ten  grains  of  Dover's  powder.  Tincture  of 
belladonna  five  drops  every  three  hours  may  be  given;  or  the  following: 
antipjTine  five  grains  every  hour  until  four  doi?es  are  taken,  then  every 
three  hours  Tintil  relieved;  acetanilid  five  gi-ains  in  the  same  manner; 
tincture  of  gelsemium  ten  drops  every  three  hours;  bromide  of  soda  or 
potassium  twenty  to  thirty  grains  every  three  hours;  or  as  a  final  resort, 


EXCESSIVE   MENSTRUATION.  643 

if  the  above-named  remedies  fail  to  afford  relief,  morphine,  either  by  the 
mouth  or  a  hypodermic  injection,  but  only  ou  the  advice  of  a  physician. 
Hot  vaginal  injections  should  also  be  tried,  using  at  least  a  gallon  of 
water. 

Purgation. — Often  when  the  attack  is  accompanied  by  constipation, 
a  purgative  dose  of  epsom  salts  or  aloes  will  be  of  service. 

Attention  to  the  General  Health — Between  the  attacks  attend  to  the 
general  health.  Emjjloy  the  tonics  mentioned  in  the  treatment  of  amen- 
orrhea. Take  plenty  of  out-of-door  exercise.  Avoid  undue  excitement, 
straining  or  heavy  lifting,  the  bicycle  and  dancing,  as  the  time  for  the 
flow  approaches. 

Prevention  of  the  Pain — An  endeavor  should  be  made  to  prevent  the 
pain  if  jjossible.  The  best  drug  for  this  purpose  is  tincture  of  gelsemium, 
five  drops  after  meals,  to  begin  ten  days  before  the  flow  is  expected.  This 
is  to  be  continued  until  the  flow  is  well  established,  then  cease  until  within 
ten  days  of  the  next  period.  It  will  prove  advantageous  at  times  to  com- 
bine with  the  gelsemium  five  drops  of  the  tincture  of  cannabis  indica. 

When  Drugs  Fail. — If  drugs  fail  to  afford  relief,  then  it  may  be  nec- 
cessary  to  dilate  and  curet  (scrape)  the  womb,  an  operation  which,  when 
properly  performed,  will  give  excellent  results.  This  operation  will  only 
keep  the  patient  in  bed  ten  days,  and  at  the  end  of  the  second  week  she 
V  ill  be  able  to  resume  her  routine  duties. 

EXCESSIVE  MENSTRUATION  (Menorrhagia  and  Metrorrhagia). 

Meaning  of  the  Disease — When  the  monthly  flow  persists  longer  than 
hsual  or  is  excessive  in  amount  it  is  called  menorrhagia.  When  there 
is  a  bloody  discharge  from  the  womb  between  the  monthly  periods  it  is 
termed  metrorrhagia. 

Causes. — Both  may  be  due  to  obstruction  of  the  general  circulation 
of  the  blood,  from  disease  of  the  heart,  lungs  and  liver.  Tumors  of  the 
womb,  inflammatory  disease  of  the  womb,  ovaries  and  tubes.  The  more 
frequent  causes  are,  getting  out  of  bed  too  soon  after  confinement,  re- 
tained portions  of  conception,  due  to  im2'>roper  care  during  a  miscarriage 
(see  Miscarriage),  polypus  tumors  of  the  womb  and  cancer. 

Symptoms — Anyone  suffering  from  either  of  these  conditions  should 
be  examined  by  a  physician  in  order  that  he  may  ascertain  the  exact 
caucs  and  remove  it ;  otherwise  delay  due  to  home  treatment,  should  the 
cause  be  a  dangerous  one,  may  prove  fatal.     In  a  woman  otherwise  having 


644  DISEASES  PECULIAR  TO  WOMEN. 

a  iionnal  flow,  she  will  notice  that  the  flow  lasts  a  day  or  two  longer,  or 
may  be  excessive  iu  amount,  requiring  a  greater  number  of  napkins  than 
usual. 

Excessive  Flow — The  flow  may  be  so  excessive  as  to  require  rest  in 
bed.  AMien  a  large  amount  of  blood  is  lost  there  will  be  pallor  of  the  skin, 
dizziness,  headache,  extreme  prostration,  specks  will  appear  before  the 
eyes,  she  mjay  feci  as  though  she  was  falling  through  the  bed.  Or  again, 
if  the  condition  present  is  a  menon-hagia,  there  will  be  a  discharge  of 
blood  between  the  periods,  which  discharge,  if  it  becomes  excessive,  will 
give  rise  to  the  same  symptoms  just  mentioned. 

Treatment. — In  the  treatment  of  menorrhagia  there  are  two  indica- 
tions to  be  fulfilled,  first  to  check  the  present  hemorrhage;  and,  second, 
to  remove  the  cause  upon  which  it  depends,  and  so  obviate  the  certainty 
of  its  recurrence.  To  accomplish  the  first  of  these  desirable  objects,  which 
should  not,  however,  be  attempted  in  any  monthly  period,  until  the  usual 
amount  of  blood  has  been  eliminated  from  the  system,  say  until  the  second 
or  third  day  of  the  flow,  try  half  a  leaspoonful  of  ergot  every  three  hours. 
Kest  in  bed  is,  however,  an  important  part  of  the  treatment,  without 
which  all  the  good  accomplished  by  skilKul  medical  care  may  be  speedily 
dissipated.  Other  remedies  are,  half  a  teaspoonful  of  hydrastis  cana- 
densis every  three  hours ;  half  a  teaspoonful  of  witch  hazel  every  three 
hours;  gallic  acid,  5  grains  every  four  hours.  Stypticin  iu  5  grain  doses. 
A  very  good  prescription  for  bleedings  of  this  kind  is  as  follows : 

R. — Ext.  hydrastis  fluid   (colorless)    i  ounce 

Ext.  ergot  fluid    V2  ounce 

Ext.  hamamelis    fluid    I  ounce 

Aqua,   q.  s , 3  ounces 

Sig.     One  teaspoonful  every  tliree  hours. 

Plugging  the  Vagina — If  these  remedies  fail  and  the  case  is  an 
urgent  one,  it  will  be  necessary  to  tampon  or  plug  up  the  vagina  with 
pieces  of  raw  cotton,  lamb's  wool,  or  linen  cloth,  taking  care  not  to  employ 
an  undue  amount  of  force  in  introducing  these  materials.  They  should 
have  a  string  securely  attached  to  theml  in  order  to  facilitate  their  re- 
moval. In  no  case  should  such  a  plug  or  tampon  be  allowed  to  remain 
longer  than  t\Venty-four  to  thirty-six  hours,  for  fear  of  poisoning  the 
system  with  the  putrifying  blood  entangled  in  it.  When  the  tampon  has 
been  removed,  if  tlie  bleeding  is  not  checked,  tampon  again. 

Removal  of  Tumors. — If  the  bleeding  is  due  to  the  presence  of  tumors, 
it  will  be  necessary  to  have  them  removed. 


LEUCOEEHEA  OR  WHITES.  645 

Further  Treatment — Freqxiently  medicines  and  tampons  fail  to  con- 
trol the  henioiThages,  esjjecially  when  there  is  proud  flesh  in  the  womb, 
and  when  the  muscles  of  the  womb  are  unable  to  contract.  In  such  an 
event  the  only  procedure  is  to  dilate  and  euret  the  womb,  which  operation 
will  remove  the  source  of  the  trouble.  In  some  cases  of  dysmenorrhea 
enlargement  and  congestion  of  the  ovaries  appear  to  be  the  important 
factors  in  the  production  of  the  malady.  Such  attacks  are  apt  to  be  very 
intractable,  imless  the  disordered  conditions  of  the  ovaries  are  remedied, 
usually  by  an  operation. 

LEUCORRHEA  OR  WHITES. 

Character  of  Whites. — This  prevalent,  troublesome  and  disagreeable 
condition,  vulgarly  termed  the  "whites,"  consists  of  a  discharge  of  mucus 
or  muco-pns  from  the  womb,  neck  of  the  womb  and  vagina.  It  is  very 
similar  to  that  occurring  from  the  nose  during  a  cold  in  the  head.  In  fact, 
the  condition  of  the  mucous  membrane  giving  rise  to  leucorrhea  is  often 
one  of  catarrhal  inflammation. 

Causes — It  may  be  brought  on  by  taking  cold ;  by  local  excitement ; 
by  inflammation  of  the  neck  of  the  womb,  the  womb  proper  or  the  lining 
membrane  of  the  womb;  oftentimes  the  trouble  is  localized  in  the  raucous 
membrane  of  the  vagina;  disease  of  the  ovaries  and  tubes  may  also  be  at 
fault.  It  is  frequently  due  to  a  "ran  down"  system,  yet  women  in  perfect 
health  may  be  affected ;  in  the  latter  class  it  is  probably  nature's  method 
of  overcoming  an  excess  in  the  richness  of  the  blood. 

Character  of  the  Discharge. — The  character  of  the  discharge  varies; 
it  may  be  thick  and  tenacious,  or  it  may  be  liquid,  when  it  will  run  down 
the  limbs  in  a  stream  and  greatly  soil  the  clothing.  As  ordinarily  seen, 
it  is  not  usually  accompanied  with  much  pain,  but  when  very  profuse,  dis- 
tress in  the  back  and  a  dragging  sensation  in  the  lower  part  of  the  pelvis, 
often  described  as  a  bearing  down  feeling,  are  the  sjanptoms  most  fre- 
quently observed.  The  discharge  is  generally  more  abundant  a  little 
while  before,  and  for  two  or  three  days  after  the  occurrence  of  the  flow. 
In  fact,  when  the  leucorrhea  is  severe,  this  increase  of  the  flow  of  whitish 
matter  sometimes  continues  for  a  couple  of  weeks  after  the  monthly  period 
with  increased  violence,  showing  how  greatly  it  depends  upon  a  congestion 
of  the  parts  concerned  for  its  jiroduction. 

Treatment. — The  treatment  of  this  rather  intractable  malady,  besides 
the  necessary  attention  to  the  general  health,  by  the  use  of  tonics  and  noup- 


646  DISEASES   PECULIAE   TO   WOMEW. 

ishing  food,  consists  of  llie  employment  of  astringent  injections  into  the 
vagina.  For  building  up  the  health  the  following  pill  will  he  found  of 
service : 

R. — Acidi  arseniosi   (arscnious  acid)    I  grain 

Ferri  reducti    (reduced  iron)    lo  grains 

Quinia   sulph.    (quinine)     20  grains 

M.    Fiat  in  pil.  No.  XX.     Sig. — One  pill  after  each  meal  and  at  bedtime. 

Additional  Treatment. — If  the  leucorrhea  is  due  to  irritation  of  the 
ovaries,  ajiplj  a  cantharidal  plaster  over  the  groin  on  both  sides.  The  best 
results,  however,  are  attained  by  the  employment  of  vaginal  injections, 
such  as  a  teaspoonful  of  ereolin  to  two  quarts  of  hot  water ;  twenty  grains 
of  sulphate  of  zinc,  or  ten  grains  of  sulphate  of  copper  in  the  same  quantity 
of  water ;  thirty  grains  of  alum  to  the  pint ;  and  a  teaspoonful  of  lysol  to 
two  quarts  of  water  are  all  worthy  of  a  trial.  A  very  cheap  injection  is 
made  by  adding  one  ounce  of  powdered  oak  bark  to  each  pint  of  water,  or 
one  ounce  each  of  tannic  acid  and  glycerine  to  two  quarts  of  water. 

Treatment  for  Petid  Discharge — When  the  discharge  is  fetid,  perman- 
ganate of  potassium  should  be  used  one-half  drachm  to  one  pint  of  water. 
This  solution  will  stain  linen,  so  be  careful  to  avoid  sjilashing  It  over  the 
douche  pan.  (See  IIow  to  Use  the  Douche.)  Another  veiy  good  drug  to 
eradicate  the  odor  of  this  discharge  is  bichloride  of  mercury.  The  drug- 
gists dispense  a  tablet  containing  seven  and  seven-tenths  grains  of  the 
drug.  One  of  these  tablets  added  to  two  quarts  of  water  makes  a  solution 
the  strength  of  which  is  1-4000.  Such  a  soltition  should  be  used  two  or 
three  times  a  day.  All  the  injections  above  mentioned  can  be  used  night 
and  morning,  but  if  the  discharge  is  profuse,  three  times  a  day  will  not  bo 
too  often. 

An  Injection  for  Whites — A  very  useful  astringent  injection  for 
leucorrhea,  whatever  may  be  its  cause,  is  the  vaginal  astringent  douche 
tablet. 

This  tablet  can  be  used  night  and  morning  and  is  effective  and  con- 
venient. 

local  Applications.^TThen  the  leucorrhea  is  caused  by  catarrhal  in- 
flammation of  the  cavity  of  the  womb,  as  is  frequently  the  ease,  injections 
into  the  vagina  are,  of  course,  almost  worthless,  and  local  applications 
made  by  a  j^hysician  are  very  important,  and  should  be  faithfully  perse- 
vered in,  sometimes  for  many  months. 


HOW   TO   USE  THE  DOTJCHa.  647 


HOW  TO  USE  THE  DOTJCHE  OR  VAGINAL  INJECTION". 

Varieties  of  Syringes — Before  proceeding  further  let  me  describe  the 
proper  manner  of  taking  a  douche.  First  the  varieties  of  syringes.  These 
are  numerous,  but  for  practical  purposes  there  are  only  two  which  aro 
used  to  any  extent.  They  are  the  Davidson,  or  bulb  syringe,  and  the 
Fountain  syringe. 

The  Bulb  Syringe. — The  bulb  syringe  is  not  to  be  recommended,  be- 
cause it  is  dirty,  a  great  deal  of  muscular  energy  is  required  to  work  it, 
hence  is  tiresome  and  necessitates  too  much  preparation  for  its  use.  It 
is  very  difficult  to  employ  this  syringe  while  lying  down,  and  this  is  the 
only  position  in  which  a  douche  should  be  taken. 

Using  the  Bulb  Syringe — In  using  this  kind  of  a  syi-inge  generally  a 
pint  of  the  solution  is  placed  in  a  basin  over  which  the  woman  squats,  and 
by  sqTieezing  the  bnlb  forces  the  liquid  into  the  vagina  as  fast  as  it  runs  out, 
thereby  filling  the  syringe  joints  with  the  vaginal  secretions,  and  returning 
to  the  vagina  as  soon  as  they  flow  away  the  iminirities  which  have  left  it. 
If,  however,  a  woman  prefers  this  kind  of  a  syringe,  and  insists  on  sitting 
over  a  bucket  or  other  receptacle,  then  the  solution  should  be  placed  in 
one  basin,  and  that  which  is  forced  into  the  vagina  pennitted  to  run  into 
the  vessel  upon  which  she  is  sitting. 

Object  of  Using  the  Syringe. — The  object  of  using  the  syi-inge  is  to 
bathe  the  vagina  and  neck  of  the  womb.  By  sitting  on  a  vessel  the  latter 
is  prevented,  for  just  as  soon  as  a  woman  sits  down,  then  the  vagina  is 
doubled  on  itself  in  such  a  manner  as  to  prevent  the  solutions  reaching  the 
womb. 

The  Fountain  Syringe — The  Fountain  syringe  is  to  be  advocated,  not 
only  for  this  purpose,  but  for  all-round  family  use.  This  syringe  consists 
of  a  bag  of  soft  rubber  with  a  long  tube  and  a  series  of  hard  rubber 
nozzles.  The  largest  size  is  intended  for  the  vagina.  The  "Alpha"  is  the 
best,  because  it  has  a  valve  at  the  opening  which  prevents'  the  solution  from 
running  out  at  the  top.  This  is  a  great  advantage  because  the  bag  can  be 
laid  on  the  floor,  a  shelf  or  anywhere  without  spilling  its  contents. 

Proper  Way  to  Take  Vaginal  Injections. — The  proper  way  to  take  a 
vaginal  injection  is  as  follows:  First  fill  the  douche  bag,  which  should 
hold  at  least  two  or  four  quarts,  with  the  solution  which  is  to  be  nsed. 
Hang  it  on  a  nail,  which  should  be  driven  near  the  bed.  Then  place  the 
douche  pan  on  the  bed.    A  good  douche  pan  should  be  large  and  capable  of 


648  DISEASES   PECULIAE  TO   WOMEN. 

holding  at  least  one  to  two  gallons.  They  are  made  of  tin  and  agateware. 
Then  lie  down  in  i)ed,  placing  the  douche  pan  imdcr  you  in  such  a  position 
that  tlie  buttocks  rest  on  the  top  of  the  pan,  in  order  that  the  solution  after 
leaving  the  vagina  will  run  directly  into  the  pan  without  splashing  over. 

Improper  Positions  in  Douching. — This  is  the  correct  way  to  take  a 
douche.  The  other  methods  of  sitting  over  a  basin,  or  standing  over  a 
vessel,  are  to  be  condemned.  This  is  the  only  way  in  Avhich  the  womb  can 
be  bathed  with  the  solution  nsed,  and  not  less  than  one  to  two  quarts 
should  be  emijloyed  when  a  drug  has  been  added;  and  when  plain  hot 
water  is  used,  four  to  six  quarts  will  not  be  too  many. 

Temperature  of  Douches. — All  vaginal  douches  should  be  as  hot  as  the 
patient  can  stand,  and  under  no  circumstances  should  cold  water  be  used, 
as  it  is  injurioiis.  In  exceptional  cases  hot  water  increases  the  pain  in- 
stead of  relieving  it,  and  is  then  advantageously  replaced  by  lukewarm 
water. 

What  Women  Should  Avoid — Under  no  condition  should  a  woman  en- 
deavor to  introduce  the  small  nozzle  into  the  womb,  or  endeavor  to  force 
a  solution  of  any  kind  into  the  womb.  This  is  an  exceedingly  dangerous 
practice,  and  many  a  woman  by  so  doing  has  sown  the  seed  of  pelvic  in- 
flammation, which  has  only  been  relieved  by  the  removal  of  both  ovaries, 
aud  in  some  cases  the  womb. 

CONSTIPATION. 

Woman  a  Constipated  Animal. — The  eminent  Dr.  Goodell  once  said: 
"Woman  is  a  constipated  animal."  While  we  do  not  desire  to  class  the 
gentler  sex  as  an  animal,  still  this  statement  contains  a  gi-eat  deal  of 
truth,  for  by  far  the  greater  majority  of  women  are  constipated. 

Causes — This  troublesome  state  can  be  attributed  to  a  number  of 
causes,  the  most  frequent  of  which  is  leading  a  sedentary  life;  omitting 
daily  exercise,  which  tends  to  excite  the  secretions  of  the  bowels  and  liver 
to  their  proper  activity.  Another  very  frequent  cause  is  laziness  pure 
and  simple,  the  patient  failing  to  go  to  stool  when  informed  by  nature 
that  such  should  occur. 

A  Very  Frequent  Cause — Modesty  is  a  very  frequent  cause  of  con- 
stipation in  women,  because  a  woman  prefers  to  suffer  rather  than  to  go 
to  a  closet  which  may  be  somewhat  publicly  situated.  Hereditary  mus- 
cular weakness,  hepatic  torpor,  lack  of  secretions  in  the  lower  bowels,  back- 


CONSTIPATION.  64:9 

•ward  displacement  of  the  womb  and  lacerations  of  the  perineum  are  fre- 
quent causes  of  constipation. 

Symptoms. — General  weakness,  a  feeling  of  languor  and  mental  de- 
pressions are  frequent  symptoms;  nervousness,  headache,  loss  of  appe- 
tite and  a  furred  tongue  may  also  occur.  Individuals  differ  in  this  mat- 
ter, one  feels  wretched  all  day  without  the  accustomed  evacuation,  another 
is  comfortable  all  the  week  except  on  the  day  which,  by  purge  or  enema,, 
the  bowels  are  relieved. 

More  Serious  Symptoms. — ^When  persistent  the  accumulation  of  the 
'feces'  leads  to  serious  symptoms,  such  as  idceration  of  the  colon,  perfora- 
tion of  the  bowel,  piles  and  inflammation  of  the  bowels.  The  bowel  con- 
tents may  become  dry  and  hard,  forming  large  masses,  which  can  only 
be  removed  by  a  physician  with  a  great  deal  of  difficulty. 

Nausea. — In  women  who  have  been  habitually  constipated,  attacks 
&f  diarrhoea  with  nausea  and  vomiting  should  excite  suspicion,  and  lead 
to  a  thorough  examination  of  the  lower  bowel. 

Poisoning. — Part  of  the  bowel  contents  may  be  absorbed  by  the  sys- 
tem, giving  rise  to  a  general  poisoning,  which  will  recur  at  stated  periods, 
until  the  constipation  is  cured.  Costiveness  is  the  recognized  cause  not 
only  of  hemorrhoids,  of  pelvic  congestion,  of  inflammation  of  the  womb 
and  of  disorders  of  the  digestive  apparatus,  but  also  of  the  fecal  poisoning 
just  mentioned.  For  if  diseases  breed  from  bad  drainage  without  the 
body,  how  much  more  from  bad  drainage  and  defective  sewerage  within 
the  body!  Feeble  mothers  beget  feeble  children — children  who  are  car- 
ried from  the  womb  to  the  grave,  or  who  peak  and  pine  under  the  heritage 
of  ill  health. 

Other  Causes. — Such  then  being  the  condition  of  the  majority  of 
American  women,  what  is  the  cause  ?  Probably  no  single  cause  has  had 
BO  much  influence  in  producing  the  peculiarly  delicate  condition  for  which 
women  living  in  the  country  and  in  small  towns  in  America  are  notorious, 
as  the  discomfort,  inconvenience  and  frequent  repulsiveness,  and,  I  may 
add,  indecent  exposure,  of  their  closet  accommodations. 

Insufficieny  of  Closet. — In  the  teeming  tenement  house  of  any  of  our 
large  cities  there  is  usually  but  one  closet,  and  that  is  invariably  a  cess- 
pool, wet  and  foul,  reeking  with  filth,  poisoned  by  noisome  stenches, 
defiled  by  lewd  couplets  or  by  obscene  cuts,  indecent  from  tliin  parti- 
tions and  wide  chinks,  or  from  being  preoccupied  by  one  of  the  opposite 
sex.  Under  such  conditions  what  woman  can  avoid  schooling  herself  into 
the  habit  of  resisting  the  evacuation  of  her  bowels  ? 


650  DISEASES   PECULIAR  TO   WOMEN. 

Inconvenient  Privies. — In  the  small  houses  of  tradesmen  and  of  me- 
chanics the  water-closet  is  rarely  to  be  found,  nor  are  the  houses  of  the 
better  classes  always  supplied  Avith  this  luxury.  The  privy  is  then  usually 
placed  at  the  farther  end  of  the  yard,  and  approached  by  a  long  and  un- 
sheltered path.  It  is,  therefore,  almost  inaccessible  in  bad  weather  or 
on  dark  nights,  and  is  overlooked  by  the  backbuildings  of  all  the  neigh- 
boring houses. 

Eisk  to  Women — To  a  delicate  woman  the  exposure  to  the  weather 
is  a  serious  risk;  to  one  who  is  menstruating  it  is  a  constant  menace; 
while  to  the  refined  woman  the  exposure  to  view  compels  the  postpone- 
ment of  her  physical  duties  to  nightfall,  or  until  driven  to  them  by  a  sheer 
necessity  which  knows  no  law. 

Country  Closets — Nor  does  the  condition  of  the  closets  in  the  coun- 
try present  a  more  agreeable  contrast.  In  many  parts  of  the  Southern 
and  Western  States  a  clump  of  bushes,  the  shelter  of  a  rock,  the  nearest 
grove  affords  the  only  accommodations.  But  take  the  most  thickly  set- 
tled States,  where  is  the  small  farmhouse  whose  privy  invites  rather  than 
repels  an  operation  of  the  bowels  ? 

Privy  a  Misnomer.-^The  very  name  of  privy  is  a  misnomer.  How 
seldom  is  the  building  hidden  by  clumps  of  evergreen,  or  a  screen  of 
lattice  work.  How  often  is  it  not  an  embarrassing  distance  from  the 
house,  at  the  end  of  a  long  trail,  or,  at  least,  of  a  long  unkept  path,  which 
frequently  runs  parallel  with  a  street  or  with  a  road. 

The  Outlandish  Privy — \Yhere  in  the  country,  and  for  that  matter 
in  cities  also,  is  not  to  be  found  the  privy  made  \ip  of  rough  boards  rudely 
spiked  together,  with  cracks  wide  enough  to  spoil  all  privacy,  with  a 
door  without  a  bolt,  and  generally  hanging  by  one  hinge,  with  a  crescent- 
shaped  hole  for  a  window,  and  with  its  sole  object  of  furniture  a  barrel 
of  rasping  corncobs  ?  When  is  it  ever  sheltered  from  the  rude  blasts  of 
winter,  or  not  poisoned  by  noisome  stenches,  acrid  vapors  and  imclean 
flies  ?  After  such  an  unsightly  but  truthful  picture,  can  we  wonder  that 
the  calls  of  nature  are  looked  upon  as  grievous  dispensations  of  Provi- 
dence, as  hateful  duties  which  are  to  be  put  off  as  long  as  possible  and 
obeyed  as  seldom  as  necessary? 

Hepellant  Conditions — Imagine  now  broad  daylight,  with  its  busy 
traffic,  a  rainy  or  a  dark  night,  the  grass  wet  with  dew,  or  the  ground  cov- 
ered with  snow,  or  the  temperature,  perchance,  many  degrees  below  zero. 
Under  such  circumstances  what  woman  can  respond  to  the  calls  of  nature 
without  putting  herself  to  great  discomfort,  to  great  risk,  indeed,  if  she 


CONSTIPATIOIT.  651 

be  menstruating,  or  without  blunting  the  edge  of  her  womanly  sense  of 
decorum. 

The  Antidote. — I  have  told  you  the  bane ;  now  what  is  the  antidote  ? 
Clearly  such  closets  as  a  civilized  Christian  people — a  people  living  in  the 
twentieth  century — are  not  degraded  in  using ;  closets  that  are  decent,  com- 
fortable and  accessible;  closets  that  invite  rather  than  repel  those  in 
which  an  operation  of  the  bowels  is  not  tantamount  to  being  buffeted  by 
Satan  for  a  season. 

Country  Earth  Closets. — In  cities,  and  in  towns  which  are  supplied 
with  water  works  and  good  drains,  the  use  of  the  water  closet  ought  to 
become  universal.  In  the  country,  where  such  a  luxury  can  be  attained 
by  the  rich  alone,  the  earth  closet  is  the  only  substitute;  I  cannot  too 
strongly  urge  its  adoption. 

Treatment — Much  may  be  done  by  systematic  habits.  Set  a  cer- 
tain time  of  the  day,  and  at  that  time  go  to  the  closet  and  endeavor  to 
have  an  evacuation.  Continue  with  this  each  day,  and  permit  nothing  to 
interfere  with  this  duty  at  that  particular  time.  The  desire  to  go  to  stool 
should  always  be  granted ;  when  there  is  a  desire,  go  by  all  means. 

Treatment  of  Stout  "Women — In  stout  women  with  flabby  abdomens 
the  muscles  should  have  the  support  of  a  bandage.  E-xercise  is  of  great 
value;  by  far  the  best  being  horseback  riding  at  least  an  hour  a  day,  or 
every  other  day.  Massaging  the  abdominal  muscles  is  also  of  value. 
Much  good  can  be  accomplished  by  the  daily  use  of  the  "home  gymna- 
sium," or  dumb  bells  and  Indian  clubs. 

Diet. — The  diet  should  also  be  regulated.  Very  often  if  a  plateful 
of  cracked  wheat  is  used  at  breakfast  each  morning,  and  bran  bread  taken 
in  addition,  a  chronic  tendency  to  constijiation  can  be  removed.  Milk 
is  not  to  be  recommended.  Green  or  caimed  corn  is  of  great  service. 
Fruits  also  do  good.  Nothing  is  so  good  as  a  glass  of  cold  water  taken  on 
arising  in  the  morning  jiist  before  breakfast ;  or  if  the  cold  cannot  be 
borne,  then  a  glass  of  as  hot  water  as  can  be  swallowed  may  be  substi- 
tuted. It  must  be  remembered  that  strawberries,  raspberries  and  black- 
berries are  constipating  rather  than  pui-gative.  Coilee  has  a  binding 
effect  on  some  persons ;  brandy  is  distinctly  constipating,  whereas  whiskey 
has  no  influence  one  way  or  the  other. 

Treatment  by  Medicines. — The  use  of  drugs  for  the  relief  of  consti- 
pation consists  in  those  that  unload  the  bowel,  which  has  become  filled, 
and  those  which  will  cure  the  tendency.  Let  us  consider  the  first  variety. 
For  this  purpose  may  be  mentioned  epsom  salts,  half  to  one  tablespoonful, 


652  DISEASES   PECULIAR   TO    WOMEN. 

preferably  taken  in  the  morning  on  an  empty  stomach;  mercury,  in  the 
form  of  calomel,  one-tifth  of  a  grain  every  hour  until  about  ten  closes  are 
taken,  then  following  with  a  bottle  of  citrate  of  magnesia ;  castor  oil,  half 
to  one  tablespoonful,  or  twenty  grains  of  powdered  rhubarb  at  bedtime. 

To  Cure  Tendency. — Of  the  second  class,  half  to  one  teaspoonful  of 
the  fluid  extract  of  cascara  sagrada  at  bedtime,  or  a  dessertspoonful  of 
phosphate  of  soda  in  one-quarter  of  a  glass  of  hot  water  before  breakfast. 
Khubarb  is  not  to  be  recommended  for  constant  use,  as  it  is  astringent, 
and  after  the  bowels  have  moved  the  constipation  will  be  more  pronounced 
than  before.  Mercury  is  exceedingly  harmful  if  used  continuously  as  a 
purge,  and  is  the  cause  of  much  ill  health,  bad  teeth,  and  digestive  troubles. 
Castor  oil  is  notorious  for  its  tendency  to  ultimate  constipation. 

Very  Best  Drugs — Of  the  curative  class  of  drugs  none  compare  to 
cascara  sagrada,  which  should  be  used  in  the  form  of  the  tasteless  fluid 
extract,  or  cascara  cordial.  This  is  the  only  drug  which  moves  the  bowels 
and  at  the  same  time  tends  to  make  the  future  movements  more  easy  and 
regular;  the  dose  is  ten  to  twenty  drops  of  the  fluid  extract  every  night 
at  bedtime,  or  one  to  six  teaspoonfuls  of  the  cordial.  If  the  fluid  extract, 
in  the  doses  above  mentioned,  fails  to  act,  increase  the  quantity  each  night 
until  at  least  a  teaspoonful  if  necessary. 

The  following  three  prescriptions  will  be  of  value : 

Aloes    20  grains 

Extract  of  nux  vomica    4  grains 

Extract  of  physostigma   3  grains 

Extract  of  belladonna    4  grains 

Make  into  twenty  pills.     Take  one  pill  at  night  or  one  night 
and  morning. 
Oy, 

Resin    of   podophyllum    2  grains 

Extract  of  nux  vomica   4  grains 

Extract   of   physostigma    3  grains 

Extract   of  belladonna    4  grains 

Make  into  twentv  pills.    Take  one  at  night  or  night  and  morning. 

Or, 

Aloin     2  grains 

Extract  belladonna    2  grains 

Strychnine     ^*  grain 

Extract   cascara    i6  grains 

Make  into  l6  pills.     One  at  night. 

Injections. — The  employment  of  enemas,  or  injections,  as  a  routine 
practice  is  to  be  discouraged.     In  cases  where  it  is  necessary  to  use  them 


DISEASES   OP  THE  EXTERNAL  GENITAL   OEGANS.  653 

for  temporary  relief,  and  to  get  rid  of  tlio  gas,  a  little  soap,  eommon  salt, 
,  and  a  few  drops  of  turpentine  may  be  added  to  the  water. 

DISEASES  OF  THE  EXTERNAL  GENITAL  ORGANS. 

Vtilvitis. — This  is  an  inflammation  of  the  vulva,  the  part  so  often 
referred  to  by  women  as  their  "person"  or  "privates."  It  is  divided  into 
several  different  varieties,  which  can  only  be  distinguished  by  a  physician. 

Causes. — One  of  the  most  frequent  is  lack  of  cleanliness;  irritating 
discharges  from  the  vagina  and  womb,  -which  trickle  over  the  parts ;  tight 
fitting  drawers,  which  rub  and  chafe;  injuries,  as  striking  against  chair, 
or  falling  on  an  object;  selfabuse;  excessive  or  brutal  intercourse;  preg- 
nancy ;  fevers ;  may  follow  a  long  and  difficult  labor ;  and  is  apt  to  occur 
during  an  attack  of  diabetes. 

Symptoms — General  discomfort,  sensations  of  burning  which  amount 
at  times  to  severe  pain ;  burning  pain  during  urination ;  the  parts  are 
usually  swollen  and  very  red.  In  diabetic  vulvitis  the  itching  is  intense 
and  oftentinies  is  the  first  symptom  of  diabetes.  Every  woman  -who  passes 
large  quantities  of  water  and  suffers  from  intense  itching  of  these  parts 
should  have  her  urine  analyzed  to  see  if  it  is  due  to  diabetes.  Owing  to 
the  fever  and  swelling  the  parts  at  first  are  dry,  due  to  the  lack  of  secre- 
tion; but  as  this  increases  the  parts  become  raw  and  very  painful. 

Treatment — Cleanliness  is  the  first  consideration.  Warm  sitz  baths, 
hot  vaginal  injections'  of  plain  water,  or  water  to  which  has  been  added 
creolin  one-half  a  teaspoonful  to  two  quarts,  borax  a  teaspoonful  to  the 
quart,  or  a  dessertspoonful  of  salt  to  the  quart.  Use  these  several  times 
a  day.  After  thoroughly  cleansing  the  parts,  they  may  be  dusted  with 
talcum  powder,  starch,  or  starch  and  bismuth,  equal  quantities,  bismuth  or 
borax. 

Checking  the  Beginning.— Oftentimes  the  attack  can  be  checked  at  the 
beginning  by  applications  of  lead-water  and  laudanum.  The  best  way  to 
apply  this  is  to  soak  a  piece  of  absorbent  cotton,  about  the  size  of  the  hand, 
with  it,  and  place  it  in  between  the  legs. 

Treatment  by  Injection — If  the  irritation  is  due  to  worms,  a  rectal 
injection  will  usually  remove  them.  If  the  itching  is  very  severe  try  hot 
vaginal  injections  of  bichloride  of  mercury,  seven  grains  to  the  quart; 
salicylic  acid  the  same  strength;  or  a  solution  of  hyposulphite  of  soda,  one 
ounce  to  the  pint  of  water.  After  the  parts  have  been  dried  any  of  the 
followiug  will  be  found  beneficial:   benzoated   zinc   ointment;   iodofoi-m 


654  DISEASES   PECUT.IAR   TO   WOMEN. 

ointment;  solution  of  carbolic  acid,  half  a  teaapoonfiil  to  a  cup  of  water; 
uitrate  of  silver,  eight  grains  to  the  ounce  of  distilled  water,  and  painted 
over  tlie  parts  oftentimes  affords  the  greatest  relief.  The  bowels  should 
be  kept  freely  open. 

PRURITUS  (ITCHING  OF)  VULVA. 

Definition. — By  pruritus  is  meant  itching;  the  privates  are  the  one 
part  of  a  woman  most  frequently  affected  with  this  troublesome  condition. 
Pruritus  is  not  a  disease,  but  a  symptom  of  other  conditions. 

Causes. — It  is  of  frequent  occurrence  during  pregnancy,  and  very 
often  the  result  of  uncleanliness ;  is  invariably  caused  by  irritating  dis- 
charges from  the  vagina;  may  be  associated  with  tumors  of  the  parts,  and 
is  often  present  during  the  course  of  diabetes. 

Symptoms. — Intense  itching,  the  woman  is  almost  driven  to  despera- 
tion, and  scratches  the  parts  until  they  bleed.  The  itching  is  usually 
aggravated  by  walking  or  becoming  warm  in  bed.  This  condition  may  be 
so  marked  as  to  lead  to  melancholia.  The  intense  suffering  causes  loss  of 
sleep,  exhaustion,  and  sometimes  alarming  nervous  depression.  The  more 
the  patient  is  compelled  to  scratch,  the  more  the  parts  are  irritated. 

Treatment. — Eemove  the  cause  if  it  can  be  found.  In  order  to  re- 
move irritating  discharges  sitz  baths  and  vaginal  douches,  as  described  in 
the  treatment  of  vaginitis,  are  used.  After  thorough  cleansing  of  the 
parts  they  may  be  dusted  with  calomel,  bismuth,  starch  or  lycopodium 
powder.  The  calomel  is  generally  preferred.  Before  applying  the  powder 
first  dry  the  parts.  Great  relief  is  sometimes  experienced  from  a  gauze 
compress  over  the  vulva,  saturated  with  a  solution  of  lead-water  and 
laudanum,  equal  parts.     This  dressing  should  be  frequently  changed. 

Auxiliary  Treatment. — The  intense  itching  which  appears  at  night 
after  retiring  can  often  be  prevented  by  applying  to  the  vulva  cloths  wrung 
out  in  hot  water.  Ointments  are  useful  from  their  soothing  effects  and,  in 
addition,  they  protect  the  parts  from  the  irritating  discharges.  These  are 
iodoform  ointment,  sulphur  ointment  and  zinc  ointment. 

HEMATOMA    (BLEEDING)    OF  THE  VULVA. 

This  term  is  applied  to  any  hemorrhage  which  may  occur  in  the 
tissues  of  the  privates.     It  usually  occurs  on  one  side,  rarely  on  both. 

Causes. — The  most  frequent  are  falling  on  a  sharp  substance;  very 
often  while  housecleaning  a  woman  will  stand  on  a  chair  which,  should  it 


SKIN   DISEASES    OF    THE    VULVA.  655 

Blip,  may  cause  her  to  fall  in  such  a  manner  as  to  straddle  the  back  of  it ; 
the  insane  may  self-inflict  wounds  in  this  spot.  Among  other  causes  are 
intercourse,  pregnancy,  tumors  and  diseases  of  the  blood-vessels  supplying 
the  affected  parts. 

Symptoms — The  symptoms  are  practically  those  of  injury  to  any 
other  part  of  the  body.  The  bleeding  may  be  very  profuse,  especially  if 
there  is  a  cut.  If  the  parts  are  only  bruised  the  bleeding  will  be  more  or 
less  extensive,  the  blood  simply  jjouring  out  into  the  tissues,  causing  a 
swelling  of  the  parts.  There  will  be  pain  of  a  sharp  or  tearing  nature, 
which  may  be  accompanied  by  faintness.  If  the  swelling  is  large,  it  may 
press  on  the  urethra,  and  cause  difficulty  In  passing  water. 

Treatment. — The  bleeding  may  be  controlled  by  the  application  of  ice 
or  by  using  pressure  or  both.  Simply  take  a  clean  napkin  and  hold  it 
tightly  against  the  injured  parts.  After  the  blood  has  been  in  the  tissues 
for  a  few  hours  a  hard  blood-clot  forms.  If  this  is  not  absorbed  within  a 
few  days  the  part  should  be  lanced  and  the  clot  turned  out.  If  the  swelling 
is  small  lead-water  and  laudanum  applied  to  the  parts  on  pieces  of  gauze 
may  cause  it  to  disappear. 

TUMORS  OF  THE  VULVA. 

The  vulva,  like  any  other  portion  of  the  body,  is  subject  to  the  occur- 
rence of  tumors  which  may  or  may  not  be  malignant.  If  such  a  tumor 
growth  should  occur  a  physician  shoidd  be  consulted,  in  order  that  he  may 
diagnose  its  exact  nature  and  institute  the  jiroper  treatment.  Too  often 
innocent  looking  growths  have  been  allowed  to  go  unattended,  which,  when 
too  late,  have  been  found  to  be  cancers. 

SKIN  DISEASES  OF  THE  VULVA. 

The  skin  of  the  vulva  may  be  affected  with  various  skin  diseases,  as 
eczema,  erythema,  acne,  herpes,  prurigo,  scabies,  pedicuH  and  erysipelas. 

Causes. — The  various  diseases  are  due  to  irritating  discharges  from 
the  vagina  or  womb,  menopause,  vesico-vaglal  fistula,  indigestion,  diabetes, 
and  in  stout  persons  during  exceedingly  hot  weather. 

Scabies. — Scabies  is  due  to  the  parasite  acorns  scabiei.  This  parasite 
may  spread  from  some  other  part  of  the  body.  This  itch-mite  burrows 
into  the  skin  and  gives  rise  to  intense  itching,  which  increases  when  the 
body  is  warm.  It  is  usually  due  to  uucleanliness  and  coming  in  contact 
■with  uncleanly  persons  similarly  affected 


656  DISEASES   rECTTLIAB  TO   WOMEN. 

Crabs Pcdiculi  are  often  found  about  the  external  genitals.     This 

is  also  a  parasite,  commonly  called  "the  crabs."  These  parasites  localize 
themselves  in  the  hair,  and  can  be  seen  clinging  to  it  They  are  generally 
contracted  through  intercoiirse  with  indecent  women.  Too  often  husbands 
thus  affected  bring  them  home  and  innocently  cause  a  similar  condition 
with  their  wives. 

Treatment — Hot  vaginal  injections,  as  advised  for  diseases  of  the 
vagina.  Local  soothing  applications  should  te  made,  such  as  bismuth 
powder,  ten  per  cent,  solution  of.  carbolic  acid,  benzoated  zinc  oxide  oint- 
ment three  to  four  times  a  day ;  powdered  zinc  oxide  three  to  four  times  a 
day;  acetanilid  and  chalk  equal  qixantities,  three  to  four  times  a  day;  car- 
bolized  zinc  ointment  three  times  a  day,  and  lycopodium  powder  several 
times  daily.  If  scabs  are  present  wash  them  off  with  almond  or  other 
bland  soap,  after  which  apply  any  of  the  above  ointments.  Keep  the 
bowels  open  daily,  resorting  to  the  treatment  as  advised  for  constipation. 

Accessory  Treatment. — If  scabies  are  the  cause  take  a  warm  bath  with 
free  use  of  soap,  followed  by  dusting  the  parts  with  sulphur.  Sulphur 
ointment  has  been  highly  recommended. 

If  due  to  pediculi,  the  best  treatment  is  to  shave  the  hair  and  thor- 
oughly rub  in  a  ten  per  cent,  ointment  of  oleate  of  mercury  three  times 
a  day,  or  blue  ointment  four  times  a  day;  bichloride  of  mercury,  five 
grains  to  a  pint  of  water,  bathing  the  parts  several  times  daily ;  or  carbolic 
acid  solution  several  times  daily. 

VAGINISMUS,  OR  CONTRACTION  OF  VAGINA. 

Vaginismus  is  a  painful  spasmodic  contraction  of  the  vagina  which 
more  or  less  prevents  intercourse. 

Causes.^ — Very  frequently  due  to  an  extremely  sensitive  condition  of 
the  remnants  of  the  hymen,  which  will  produce  violent  contraction  of  the 
muscles  of  the  vagina.  It  may  also  be  caused  by  a  fissure  of  the  vagina, 
erosions  of  the  parts,  fissures  of  the  anus  and  an  urethral  carbuncle. 

Treatment. — If  due  to  a  carbuncle  it  should  be  taken  out,  which  opera- 
tion will  confine  the  woman  to  bed  for  five  to  seven  days.  When  due  to  a 
thick  hymen  it  will  need  the  attention  of  a  physician.  Among  the  reme- 
dies which  may  be  tried  at  home  are  injections  of  a  teaspoonful  of  lauda- 
num to  a  pint  of  hot  water ;  an  ointment  of  iodoform ;  or  fifteen  to  twenty 
grains  of  bromide  of  sodium  three  to  four  times  a  day. 


DISEASES  OF  THE  VAGINA.  657 

COCCYC  GDYNIA. 

It  consists  of  a  very  painful  condition  of  tlie  muscles  at  the  very  tip 
of  the  spine.     Is  most  common  in  women  who  have  borne  children. 

Causes — Injuries  during  childbirth,  blows  and  falls  striking  the  tip 
of  the  spine,  cold  or  exposure  of  the  buttocks,  and  uterine  or  ovarian 
diseases. 

Symptoms — Severe  pains  in  the  region  of  the  tip  of  the  spine,  in- 
creased by  motion. 

Treatment — During  the  acute  attacks  it  may  be  necessary  for  a  physi- 
cian to  administer  hypodermic  injections  of  morphine  to  relieve  the  pain. 
As  a  rule  an  operation  will  be  the  only  treatment  to  render  a  complete 
cure. 

URETHRAL  CARBUNCLE. 

This  is  a  small  raspberry-like  growth  which  is  very  sensitive,  and  to 
be  found  at  the  mouth  of  the  urethra. 

Causes — These  are  uncertain.  No  definite  cause  has  as  yet  been  de- 
cided upon. 

Symptoms — It  gives  rise  to  severe  itching  and  pain.  During  urina- 
tion, as  the  water  runs  over  it,  the  pain  is  more  or  less  excruciating,  so 
marked  that  women  will  oftentimes  withhold  from  passing  their  water 
until  they  are  further  unable  to  withstand  the  calls  of  nature. 

Treatment — An  operation  is  imperative,  as  no  other  treatment  will 
afford  relief. 

DISEASES  OF  THE  VAGINA 

ATRESIA.  OF  THE  VAGINA. 

Causes. — This  means  &n  absence  of  the  vagina,  or  a  closure  of  it.  The 
child  may  be  born  this  way,  in  which  case  it  is  due  to  improper  develop- 
ment in  the  womb.  Or,  as  is  more  frequently  the  case,  it  is  acquired,  due 
to  caustic  remedies  carelessly  applied,  a  long  and  tedious  labor,  extensive 
idcerations,  and  a  hymen  which  does  not  have  an  opening. 

Symptoms — In  children  born  with  this  deformity  it  is  often  not 
noticed  until  puberty,  when  the  child  should  menstruate.  In  fact,  men- 
struation does  occur,  but  owing  to  the  absence  of  the  opening  in  the  hymen 
it  is  prevented  from  escaping  and  accumulates  in  the  womb.  Each  month 
menstrual  pains  will  recur,  but  there  will  be  a  failure  of  the  blood  to 
escape.    . 

Treatment. — This  is  purely  operative. 
d2 


658  'DISEASES   PECULIAE  TO   WOMEN. 


VAGINITIS. 

Vaginitis  19  an  inflammation  of  the  vagina. 

Causes. — A  rundown  system,  anemia,  systemic  conditions  producing 
congestion  of  the  pelvis,  such  as  pregnancy  and  tumors.  !May  be  due  to 
friction  produced  by  a  badly  fitting  pessary,  to  irritating  discharges  from 
the  womb,  to  excessive  coition. 

Symptoms. — Feeling  of  heat  in  the  vagina;  pain  in  the  pelvis;  at 
times  a  frequent  desire  to  pass  water;  itching  and  burning  about  the 
entrance  to  the  vagina;  backache;  loss  of  appetite  and  at  times  nausea; 
leucorrhea. 

Treatment. — When  the  inflammation  is  acute  Iceep  quiet,  not  neces- 
sarily in  bed.  Keep  the  bowels  open,  and  give  a  light  diet,  no  meat.  If 
there  is  much  pain  use  a  five-grain  oiiium  suppository.  If  the  itching  is 
severe  take  frequent  warm  sitz-baths  and  vaginal  douches  of  hot  water  con- 
taining either  of  the  following:  Borax  one  teaspoonful  to  the  pint,  sugar 
of  lead  water  one  teaspoonful  to  the  pint,  or  half  a  teaspoonful  of  creolia 
to  two  quarts.     These  injections  should  be  used  several  times  daily. 

MALIGNANT  TUMORS  OF  THE  VAGINA. 

The  vagina  may  be  the  seat  of  cancer.  It  may  begin  here,  or  spread 
to  this  canal  from  the  bladder,  rcctiun  or  womb. 

Symptoms. — Cancer  usually  appears  from  thirty  to  forty-five  years. 
The  important  symptoms  are  hemorrhage,  which,  often  follows  straining  at 
stool,  or  after  coition ;  a  foul  discharge,  which  is  very  repulsive ;  it  may  be 
thick,  but  as  a  rule  is  watery;  pain,  this  is  always  present,  but  not  as  a 
rule,  until  after  the  disease  is  well  developed.- 

Treatment. — The  disease  tissue  should  be  removed,  of  course,  by  a 
surgeon.  If  the  disease  is  well  advanced  before  discovered,  as  a  rule  it  is 
too  late  for  operation.  If  such  be  the  case  the  indications  are  to  maintain 
the  strength  of  the  patient,  relieve  the  pain  and  counteract  the  foul  smell- 
ing discharge.  The  first  may  be  accomplished  by  tonics  and  out-of-door 
exercise.  These  cases,  as  a  rule,  are  not  bedridden  \mtil  a  short  time 
before  death.  To  relieve  the  pain  resort  to  opium.  This  is  the  only  drug 
on  which  we  can  rely.  Begin  with  a  sixth  of  a  grain  four  to  five  times  a 
day,  gradually  increasing  it  as  needed  during  the  course  of  the  disease. 
For.  counteracting  the  odor  of  the  discharge  the  best  drug  to  use  is  perman- 


DISEASES   OF   THE   tJTEBUS   OE  WOMB.  659 

ganate  of  potash,  in  a  vaginal  douche,  five  grains  to  two  quarts  of  water. 
These  douclies  should  be  used  frequently  during  the  day. 

Auxiliary  Treatment — A  woman  suflering  from  this  disease  should 
always  wear  a  napkin,  which  should  he  burned  as  soon  as  removed  from 
her  person.  Allow  plenty  of  fresh  air  to  circulate  in  the  room.  Those  who 
handle  any  cloths  which  come  in  contact  with  these  discharges  should 
wash  their  hands  at  once,  using  plenty  of  soap  and  warm  water. 

DISEASES  OF  THE   UTERUS  OR  WOMB 

INTLAMMATION  OF  LINING  MEMBRANE  OF  WOMB  (ENDOMETRITIS). 

Inflammation  of  Lining  Membrane  of  Womb. — This  is  an  inflamma- 
tion of  the  lining  membrane  of  the  womb. 

Causes. — Often  due  to  taking  cold  just  before  or  while  menstruating. 
The  introduction  of  unclean  instruments  into  the  womb;  the  introduction 
of  knitting  needles  and  other  instruments  by  women  in  an  endeavor  to 
produce  an  abortion.  Gonorrhea  is  oftentimes  at  the  bottom  of  the 
trouble.  Inflammation  of  the  womb  often  spreads  to  this  membrane,  or 
the  inflammation  may  begin  in  this  membrrne  and  spread  to  the  womb. 

Symptoms. — There  is  a  sensation  of  we.ght  in  the  pelvis  and  slight 
pain.  The  discharge  is  at  first  profuse,  thin  and  watery,  biit  later  becomes 
thick  and  tenacious,  like  the  white  of  an  egg.  Menstruation  may  or  may 
not  be  painful. 

Treatment — ^During  the  acute  attack  rest  in  bed,  with  an  ice  bag 
over  the  lower  part  of  the  abdomen,  or  if  this  is  not  comfortable,  a  hot 
water  bag.  The  bowels  should  be  well  moved,  preferably  by  a  dose  of 
epsom  salts.  The  diet  should  consist  of  liquids,  cornstarch,  gelatine  and 
the  like.  Large  quantities  of  hot  water  should  be  used  as  vaginal  injec- 
tions three  to  four  times  a  day. 

Inflammation  of  the  Womb — ^A  new  and  effective  remedy  for  this 
disease  consists  of  a  mixture  of  five  ounces  of  vaseline  with  three  drachms 
of  boracic  acid.  Make  this  into  fifty  suppositories  and  insert  one  in  the 
vagina  each  night  on  retiring;  or,  if  found  more  convenient,  take  a  small 
piece  of  the  mass,  about  the  size  of  a  cherry,  and  insert  as  above.  This 
treatment  serves  also  to  correct  irregularity  of  the  menses.  Hot  water 
injections  daily. 


060  DISEASES   PECUNIAE  TO  WOMEN. 


INFLAMMATION  OF  THE  WALLS  OF  WOMB  (METRITIS). 

Inflammation  of  Walls  of  Womb. — Metritis  is  an  inllaunuatioii  of  the 
imiscular  •walls  of  the  womb. 

Causes. — The  most  frequent  cause  is  getting  out  of  bed  too  soon  after 
a  confinement ;  abortions ;  exposure  to  cold  during  menstruation  will  give 
rise  to  it,  also  sexual  excesses  and  lacerations  of  the  womb. 

Symptoms. — The  acute  attacks  usually  begin  with  a  chill,  generally 
followed  by  a  fever.  Pain  is  more  or  less  marked,  and  may  extend  dowai 
the  legs,  and  be  especially  troublesome  on  the  left  side  of  the  abdomen 
over  the  ovary.  The  monthly  flow  is  apt  to  be  accompanied  by  a  great 
deal  of  pain. 

Treatment. — The  treatment  is  the  same  as  endometritis. 

FIBROUS  TUMORS  OF  THE  UTERUS. 

Symptoms. — They  give  rise  to  pain,  more  or  less  severe  at  times,  and 
to  hemorrhages,  whicb  may  cause  death.  The  pain  is  especially  severe 
during  the  menstrual  period.  The  hemorrhages  may  occur  several  times 
between  the  monthly  periods,  or  the  monthly  period  itself  may  last  for  a 
week  to  ten  days. 

Treatment. — For  the  pain,  morphine  as  a  rule  is  the  only  drug  which 
affords  relief,  one-sixth  to  one-fourth  of  a  grain  every  four  hours.  Tinc- 
ture of  gelsemium,  ten  drops  every  three  hours,  may  prove  of  service. 
For  the  bleeding  try  a  teaspoonful  of  the  fluid  extract  of  hydrastis  every 
three  hours,  or  a  teaspoonful  of  the  fluid  extract  of  ergot  every  four  hours. 
If  drugs  fail  to  control  the  hemorrhage  it  may  be  necessary  to  pack  the 
vagina  with  gauze,  which  pressing  against  the  womb  usually  controls  it. 

The  following  is  a  very  good  prescription,  which  should  be  tried  in 
all  cases  of  bleeding  from  the  womb : 

R. — Extract  of  hydrastis   fluid    f colorless) i  ounce 

Extract   of  hamamelis   fluid    i  ounce 

Extract  of  ergot  fluid   '/<  ounce 

Peppermint   water,   to   make 3  ounces 

M.     Sig. — Teaspoonful  every  four  hours. 

Or,  thyroides,  one  drachm,  ilake  thirty  capsules,  one  three  times 
a  day.     Very  often  the  fibroid  can  be  removed  with  complete  success. 


ULCERATION   OF  T]1E   WOMB.  661 


POITPTTS  TXTMOR  OF  THE  WOMB. 

Character. — This  disease,  which  is  one  of  the  most  *  common  causes 
of  excessive  hemorrhage  from  the  womb  at  the  monthly  periods,  is  of 
considerable  importance.  The  term  polypus  is  employed  to  designate 
especially  a  tumor  which  is  attached  to  the  inner  surface  of  the  womb  by 
a  well  defined  neck  or  pedicle. 

Symptoms. — The  most  important  is  profuse  menstruation.  After  a 
time,  as  the  tumor  grows  larger,  and  becomes  more  of  an  irritant,  there  are 
likewise  frequent  discbarges  of  blood  between  the  periods,  often  amount- 
ing to  attacks  of  flooding.  There  is  also  a  leucorrheal  discharge  which 
may  be  tinged  with  blood.     Occasionally  there  are  paroxysms  of  pain. 

Treatment. — Unless  the  tumor  is  removed  the  case  is  hopeless.  The 
operation  sim2:)ly  consists  in  twisting  the  polypus  off  of  its  pedicle  or  neck. 
The  patient  is  required  to  stay  in  bed  ten  days  to  two  weeks. 

■UICERATION  OF  THE  WOMB. 

Cause. — In  a  majority  of  cases  inflammation  of  the  neck  of  the  womb 
is  soon  followed  by  ulceration.  This  appears  around  the  neck  of  the 
womb,  and  just  within  the  womb's  neck. 

Symptoms — 1.  The  inflammations  and  ulcerations  mix  and  run  into 
each  other,  resulting  in  raw  places,  granulations  or  pimply  surfaces,  and 
hardened  parts.  Sometimes  the  pimply  patches  become  red  and  hard,  the 
whole  surface  spongy,  and  bleeding  will  set  in  on  the  slightest  touch. 

2.  As  ulceration  progresses  it  wrecks  the  mouth  of  the  womb  and 
eats  deeply  into  the  womb  cavity,  giving  it  an  imsightly  appearance.  Pus 
or  matter  flows  freely  at  times  and  at  other  times  scantily.  It  may  be 
thick  and  yellow,  or  thin  and  of  lighter  color.  A  sensation  of  heat  and 
smarting  exists  and  sometimes  severe  pain  in  the  right  side  of  the  ab- 
domen and  in  the  back  part  of  the  head. 

Menstruation — Ulceration  generally  changes  the  character  of  the 
menstruation.  Sometimes  it  becomes  profuse  and  painful,  at  others 
scanty;  and  then  it  may  be  either  frequent  or  tardy,  giving  rise  to  dis- 
tress and  pain  in  the  lower  part  of  the  bowels  and  even  in  the  groins  and 
thighs. 

Treatment — 1.  A  tea  made  of  the  white  pond  lily,  affords  an  excel- 
lent remedy.  It  should  be  used  internally  and  as  an  injection ;  in  the 
former  ease  in  doses  of  half  a  teacupful  three  times  daily.     The  fluid  ex- 


6B2       •  DISEASES   PBCtTLIAR  TO   WOMEN. 

tract  may  be  used  in  place  of  the  tea  in  ten-  or  fifteen-drop  doses  twice 
a  day. 

2.  Tannic  acid,  or  in  place  of  it  a  decoction  of  oak  bark,  used  as  an 
injection  night  and  morning,  gives  excellent  results. 

3.  The  application  of  tannic  acid  directly  to  the  ulcers  has  effected 
many  cures. 

4.  Ilalf  a  teaspoonful  of  boracic  acid  to  a  pint  of  water,  injected 
when  warm,  and  repeated  twice  a  day,  is  a  highly  recommended  remedy. 

5.  A  decoction  of  golden  seal  used  twice  a  day  as  an  injection  has 
been  found  to  give  satisfactory  relief. 

Accessory  Treatment. — Where  injections  are  depended  upon,  their 
virtue  can  be  increased  by  simple  injections  of  warm  water  between  times, 
and  as  often  as  every  two  or  three  hours. 

CANCER  OF  THE  WOMB. 

Character. — The  womb  is  the  one  part  of  a  woman's  body  most  fre- 
quently attacked  by  cancer.  The  disease  may  begin  in  the  neck  or  the 
body  of  the  womb.  "When  situated  in  the  neck  of  the  womb  it  looks  not 
imlike  a  cauliflower,  hence  the  term  "cauliflower  cancer." 

Causes. — It  is  more  frequent  among  the  whites.  The  lower  classes 
are  more  susceptible  than  the  upper.  It  is  extremely  rare  that  a  woman 
who  has  not  borne  a  child  is  ever  affected  with  cancer  of  the  womb.  In 
Tinmarried  women  who  have  had  cancer  of  this  organ  the  confession  of  an 
abortion  has  often  been  elicited,  showing  that  pregnancy  had  occurred. 
As  a  rule  a  badly-lacerated  ceiwix  (neck  of  the  womb)  is  very  prone  to 
cancer,  the  disease  invariably  starting  in  such  a  state  of  affairs. 

Heredity  plays  a  more  or  less  important  role,  especially  when  can- 
cer existed  in  the  mother,  or  the  mother's  side  of  the  family. 

Symptoms — In  the  very  early  stages  they  are  absent.  As  the  disease 
progresses  the  following  will  appear:  1.  Hemorrhages.  2.  Uterine  dis- 
charges.    .3.  Pain.     4.  Visceral  disorders.     5.   Cachexia. 

Hemorrhage — This  is  usually  the  first  symptom,  and  is  generally  due 
to  ulceration  and  breaking  down  of  the  parts.  Unfortunately  it  is  at- 
tributed to  the  irregularities  of  the  menopause,  or  to  a  return  of  the 
monthly  flow  after  that  period.  Hence  it  is  the  bleeding  of  cancer  is 
very  often  disregarded  until  it  has  progressed  beyond  the  hope  of  a  cure. 
The  reappearance  of  hemorrhage  two  or  three  years  after  the  menopause 
is  strong  proof  of  cancer  and  should  receive  immediate  attention. 


OAKCER  OF  THE  WOMB.  663 

Examination. — Every  ■woman  who  Las  passed  the  fortieth  year,  and 
has  vaginal  bleeding,  or  leucorrheal  discharge  mixed  with  blood,  should  at 
once  consult  a  physician  and  insist  upon  an  examination  being  made.  Too 
often  women  through  a  mock  modesty  or  for  other  reasons  refuse  to  have 
an  examination,  and  this  stubbornness  has  cost  many  a  woman  her  life. 
The  symptoms  of  many  of  the  diseases  of  the  womb  and  ovaries  are  sim- 
ilar, and  it  requires  a  thorough  examination,  at  times  under  an  anesthetic, 
in  order  to  ascertain  the  true  condition  of  the  pelvic  organs. 

Pain — This  does  not  appear  early,  but  late  in  the  disease,  as  a  rule 
too  late  for  an  operation.  As  the  disease  progresses  the  pain  will  spread 
over  the  entire  portion  of  the  lower  abdomen,  especially  so  when  the 
bladder  and  rectum  become  involved;  the  pain  is  excruciating  and  intol- 
erable. This  torture  is  constant  and  docs  not  ease  of  its  own  accoimt.  A 
woman  suffering  from,  cancer  of  the  womb  truly  does  live  a  hell  upon 
earth. 

Visceral  Disorders. — These  are  generally  due  to  the  extension  of  the 
disease,  or  to  the  pressure  of  the  womb  on  the  surrounding  organs.  The 
bladder  becomes  very  irritable,  there  is  a  constant  desire  to  pass  urine, 
and  the  patient  will  strain  and  strain  in  an  endeavor  to  squeeze  out  a  few 
drops  in  order  to  obtain  a  little  relief.  As  the  ulceration  progresses 
fistulas  may  develop,  the  openings  extending  into  the  womb,  the  bowels  or 
the  rectum.     Constipation  becomes  very  troublesome. 

Cachexia — This  is  a  characteristic  symptom,  and  appears  several 
weeks  after  the  onset  of  the  disease.  It  consists  of  a  peculiar  yellowish 
discoloration  of  the  skin  of  the  entire  body.  It  is  marked  by  emaciation, 
and  the  patient  may  waste  away  to  "skin  and  bones." 

Treatment. — If  seen  early  and  the  disease  is  limited  to  the  womb, 
this  organ  should  be  removed  at  once.  If  the  disease  does  not  return  in 
three  years  then  the  woman  is  fairly  safe.  But  if  the  disease  is  not  limited 
to  the  womb  and  has  spread  into  the  surrounding  structures,  and  an 
operation  be  performed,  the  cancer  is  very  liable,  and  invariably  does, 
return. 

Use  of  Morphine — If  the  woman  refuses  operation,  or  should  an 
operation  be  performed  and  the  disease  return,  there  is  only  one  drug  that 
will  ease  the  pain,  and  that  is  morphine.  The  patient  must  practically  be 
kept  under  its  influence.  In  short,  she  becomes  an  opium  fiend,  not 
through  choice,  but  from  necessity.  This  drug  may  be  given,  one-quarter 
of  a  grain  three  to  four  times  daily,  increasing  the  dose  as  required ;  but 
always  by  the  advice  of  a  physician. 


664:  DISEASES   PECUI.IAE   TO   WOMEN. 

Checking  the  Hemorrhage. — If  the  hemorrhage  becomes  troublesome 
it  may  be  necessary  to  curet  the  womb  in  order  to  control  it.  Drugs  have 
little  or  no  effect  on  it.  Packing  the  vagina  with  antiseptic  gauze  will  at 
times  prove  beneficial. 

Injections. — The  discharge  must  be  attacked  with  might  and  main. 
For  this  purpose  resort  entirely  to  vaginal  injections,  using  permanganate 
of  potassium,  seven  grains  to  two  quarts  of  water,  three  to  four  times 
daily ;  bichloride  of  mercury,  same  strength  and  as  often.  These  douches 
at  times  weaken  the  patient;  in  that  case  probably  two  a  day  will  be 
sufficient,  but  never  less  than  this.  The  odor  of  the  room  may  be  very 
disagreeable.  In  order  to  counteract  this  place  around  the  floor  in  saucers, 
pure  carbolic  acid,  and  air  the  room  as  often  as  possible. 

DISPLACEMENTS  OF  THE  WOMB. 

Character. — The  womb,  like  every  other  organ  of  the  body,  is  subject 
to  deviation  from  its  normal  position.  The  womb  is  situated  in  the  pelvis 
between  the  bladder  and  the  rectum.  The  bladder  is  attached  to  the  front 
of  the  neck  of  the  womb  while  the  rectum  is  very  close  to,  but  not  inti- 
mately attached  to  the  back  of  the  womb. 

WTien  the  womb  becomes  displaced  the  whole  organ  may  turn  for- 
ward (anteversion),  or  backward  (retroversion).  Or  the  womb  may  bend 
on  itself.  If  the  top  of  the  womb  falls  forward  then  it  is  called  ante- 
flexion, or  if  it  should  fall  backward  then  it  would  be  retroflexion. 

The  symptoms  and  causes  of  the  displacements  vary  more  in  degree 
than  kind. 

rOEWARD  DISPLACEMENTS. 

Causes — The  most  frequent  causes  are  clianges  in  the  uterine  tissues, 
following  an  abortion  or  confinement.  Lack  of  proper  muscular  support 
plays  an  important  part,  also  congestions,  tumors,  lacerations  of  the  pelvie 
floor,  tiglitly  fitting  clothing,  and  prolapse  of  the  vagina. 

Symptoms — Dysmenorrhea  and  sterility  are  frequently  present.  Leu- 
corrhea  may  be  troublesome.  When  the  displacement  is  so  great  that  the 
womb  presses  on  the  bladder,  this  organ  will  become  irritated,  causing  fre- 
quent irritation,  and  a  more  or  less  constant  distress  in  the  lower  part  of 
the  abdomcH.    This  irritation  may  give  rise  to  inflammation  of  the  bladder. 

Treatment. — If  the  menstruation  is  painful  use  the  remedies  as  de- 
scribed for  dysmenorrhea.  For  the  leucorrhea,  employ  the  remedies  ad- 
vised for  that  condition.    If  inflammation  be  present  local  treatments  with 


BACKWARD  DISPLACEMENTS.  665 

the  hot  vaginal  douches  are  to  be  employed.     If  a  tumor  is  the  cause  it 
should  be  removed.     The  ideal  treatment  is  to  rejilace  the  organ. 

BACKWARD  DISPLACEMENTS. 

These  include  retroversion  and  retroflexion.  These  are  the  most  fre- 
quent varieties,  and  are  more  or  less  easily  controlled. 

Causes. — General  lack  of  muscular  tone  of  the  uterine  muscles,  im- 
proper care  during  confinement,  veearing  a  tight  binder  too  long  after 
being  confined,  tumors,  pregnancy,  falls,  .blows,  distended  bladder  and 
lacerations  of  the  perineimi. 

Symptoms. — Painful  menstruation,  as  a  rule,  the  first  day  or  two  of 
the  flow,  frequent  miscarriages,  leucorrhca,  constant  dull  aching  pain  in 
the  small  of  the  back,  dragging  pains  in  the  lower  portion  of  the  abdomen 
and  thighs,  headache,  constipation,  the  bowel  movements  are  at  times 
painful,  the  bladder  may  be  irritable,  and  at  times  the  urine  may  escape 
when  the  woman  laughs  heartily. 

Treatment. — 1.  First  of  all  the  organ  must  be  replaced  in  its  normal 
position.  If  not  fastened  down  by  inflammation  a  physician  can  replace 
it;  at  times  an  anesthetic  may  be  required.  After  the  organ  is  replaced 
the  pliysician  will  introduce  a  pessary  to  keep  it  in  its  normal  position.  A 
pessary  is  a  rubber  ring  of  various  shapes.  This  instrument  should  be 
removed  at  least  once  a  month,  cleansed  and  replaced.  While  the  pessary 
is  in  the  vagina  use  a  douche  of  hikewarm  water  once  a  day.  If  the 
pessary  feels  uncomfortable,  or  is  painful  on  getting  up  or  sitting  down, 
it  should  be  taken  out  and  replaced;  if  still  giving  rise  to  trouble,  it  is 
in  all  probability  too  large,  and  a  smaller  one  should  be  tried. 

2.  If  inflammation  exists,  this  is  to  be  cured  by  local  treatments  and 
hot  vaginal  douches.  For  the  leucorrhea,  see  description  of  that  con- 
dition.    For  constipation,  see  constipation. 

3.  If  the  pessary  maintains  the  uterus  in  its  normal  position,  and  re- 
lieves all  the  symptoms,  then  it  is  optional  with  the  patient  whether  or  not 
she  will  submit  to  an  operation.  If,  however,  the  local  treatments,  and 
all  other  remedies  fail  to  afford  relief,  then  it  Mali  become  necessaiy  to 
open  the  abdomen,  and  perform  one  of  tlie  many  operations  for  sewing- 
the  womb  in  its  proper  position. 

4.  If  the  uterus  is  fastened  down  by  inflammation,  local  treatments 
will  do  no  good,  and  an  operation  will  be  the  only  proper  treatment. 


666  DISEASES    PECULIAR    TO    WOMEN. 

PROLAPSUS   (FALIING)   OF  THE  WOMB, 

Prolapsus  of  tlie  womb  is  a  descent  of  tbo  organ  below  its  proper 
position  in  tbe  pelvis,  better  known  as  "falling  of  the  womb,"  and  may 
occur  in  two  different  degrees.  The  term  prolapsus  is  applied  to  any 
falling  downward  of  the  organ,  which  is  not  so  great  that  tbo  womb 
passes  outside  tbe  body;  whilst  the  latter,  called  procidentia,  is  that  con- 
dition in  which  the  uterus  escapes  partially  or  entirely  beyond  the  ex- 
ternal organs  of  generation. 

Causes. — Falling  of  the  womb  is  more  apt  to  occur  after  maturity  is 
attained,  and  appears  especially  in  those  who  have  led  laborious  lives, 
or  who  have  exercised  themselves  too  much  in  lifting  or  carrying  heavy 
weights.  Hence  cooks,  laundresses,  market-women  and  nurses,  who  lift 
and  carry  large  and  heavy  infants,  are  especially  liable  to  suffer  from 
prolapsus.  Women  who  have  lx)rne  children  are  more  frequently  af- 
fected than  those  who  are  sterile,  and  lingering  or  instrumental  labors, 
or  getting  up  too  soon  after  confinement,  ^particularly  predispose  to  it. 
Among  the  direct  causes  may  bo  found  congestion,  hypertrophy  or  tumors 
of  the  uterus.  Violent  bearing-down  efforts  in  labor,  straining  in  ob- 
stinate constipation  and  forced  respirations,  such  as  occur  in  coughing, 
lifting  heavy  weights,  and  so  forth,  are  also  direct  causes  of  falling  of 
the  uterus. 

Symptoms — The  symptoms  of  this  complaint  are  sensations  of  full- 
ness and  weight  about  the  pelvis,  wearisome  backache,  and  leucorrhea. 
Menstruation  is  not  usually  interfered  with  and  obstinate  constipation  is 
very  common. 

As  the  prolapse  increases  the  bladder  will  be  pulled  down,  which 
■will  interfere  with  its  functions;  such  as  frequent  desire  to  void  urine, 
the  inability  to  completely  empty  it  each  time,  resulting  in  an  inflamma- 
tion of  its  mucous  membrane.  The  rectum  Avill  be  dragged  down  in  the 
same  manner,  giving  rise  to  more  or  less  difficulty  in  the  bowel  move- 
ments. 

Treatment. — In  the  first  stage,  consists  in  the  employment  of  a  pes- 
sary to  hold  the  womb  up  to  its  proper  level.  If  the  perineum  is  lacer- 
ated, this  must  be  repaired,  otherwise  a  pessary  will  drop  out.  The  only 
satisfactory  treatment  for  this  condition,  especially  when  the  womb  hangs 
out,  is  an  operation,  whicli  consists  in  amputating  the  neck  of  the  womb, 
sewing  up  the  lacerations  of  the  perineum,  and  opening  the  abdomen  in 
order  to  stitch  the  womb  where  it  belongs.    Nothing  else  will  afford  relief. 


DISEASES    OF   THE   OVARIES.  667 

This  condition  too  often  generates  cancer  of  the  womb,  and  if  the  -women 
so  affected  would  only  consent  to  have  this  operation  done  they  will  be 
free  from  all  the  symptoms  caused  by  this  displacement,  and  oftentimes 
"will  be  fortunate  enough  to  prevent  a  cancerous  growth  of  these  parts. 

DISEASES  OF  THE  OVIDUCTS. 

The  oviducts  are  two  tubes,  one  on  each  side  of  the  womb,  and  con- 
Tey  the  egg  from  the  ovary  into  the  uterine  cavity  each  month.  These 
ducts  are  subjected  to  inflammatory  disease,  which  may  terminate  in  a 
good  recovery  or  develop  into  an  abscess. 

Salpingitis.— This  is  an  inflammation  of  the  oviduct.  It  may  effect 
one  or  both  sides. 

Causes — Usually  due  to  gonorrhea,  or  poisoning  following  labor, 
catching  cold  during  the  menstrual  period,  and  excessive  exercise.  A 
cause  usually  overlooked  is  disrobing  and  lying  down  in  a  draught  after 
a  prolonged  exercise,  when  the  body  is  very  much  overheated. 

Symptoms — This  disease  may  be  acute  or  chronic.  During  the  acute 
stage  there  will  be  fever,  a  great  deal  of  pain  on  the  side  of  the  inflamed 
tube.  This  pain  is  increased  on  walking  or  standing.  The  patient  while 
lying  on  her  back  prefers  to  have  the  knees  drawn  up  and  the  lower  part 
of  the  abdomen  is  extremely  sensitive. 

During  the  chronic  stage  there  is  pain  in  the  affected  side,  which  is 
increased  on  walking,  running  up  and  down  stairs,  intercourse  and  sweep- 
ing. Menstruation  as  a  rule  is  painful,  coming  on  a  few  days  before  the 
flow. 

Treatment. — ^Rest  in  bed  during  the  acute  attacks,  and  thorough  pur- 
gation of  the  bowels.  Copious  hot  water  vaginal  douches,  at  least  twice 
a  day.  Ice  bags  over  the  lower  portion  of  the  abdomen  are  highly  recom- 
mended. 

DISEASES  OF  THE  OVARIES. 

The  ovary  may  be  attacked  by  inflammation,  wliich  may  or  may  not 
form  an  abscess,  tumors,  benign  and  malignant,  which  may  be  solid  or 
cystic. 

Ovaritis. — By  this  is  meant  an  inflammation  of  the  ovary. 

Cause. — A  frequent  cause  in  young  girls  is  too  close  confinement  in 
school,  at  work  or  overstudy.  May  be  due  to  blood  poisoning  following  a 
miscarriage  or  confinement,  to  gonorrhea,  inflammation  of  the  Avomb, 
salpingitis  and  using  a  cold  instead  of  a  hot  vaginal  douche,  standing  in 


668  DISKASTCS   PECITT.TAR   TO   WOMEN. 

a  draught  after  being  overlieated,  or  wbile  tbe  body  is  in  an  overheated 
condition,  jumping  into  a  very  cold  bath. 

Symptoms. — Tbe  jjain  is  excruciating,  and  is  situated  low  down  in  the 
abdomen,  near  the  gi'oin;  this  pain  oftentimes  shoots  down  the  log  of  the 
affected  side.  The  pain  may  extend  into  the  back  and  hip.  The  lower  part 
of  the  abdomen  is  extremely  sensitive,  and  the  sufferer  will  not  permit 
anyone  to  touch  it.  Even  the  weight  of  the  bed  clothing  may  give  rise  to 
so  much  distress  that  a  prop  will  be  necessary  in  order  to  prevent  the  bed- 
clothing  coming  in  contact  with  the  skin.  Fever  will  be  present,  the 
height  of  which  will  depend  on  the  severity  of  the  attack.  Voiding  urine, 
and  the  bowel  movements  may  be  accompanied  by  more  or  less  pain. 
These  symptoms  occur  during  an  acute  attack. 

Treatment — During  the  acute  attack  rest  in  bed  is  imperative.  An 
ice  bag  should  be  applied  over  the  affected  ovary,  providing  the  skin  is  not 
too  sensitive  to  stand  it.  If  this  is  not  well  borne,  try  a  hot  water  bag,  or 
flaxseed  poultice.  In  addition  to  these,  which  always  tend  to  ease  the 
pain,  opium  should  be  given  by  the  mouth  or  with  a  hypodermic  needle. 
When  the  pain  is  so  great  as  to  demand  opium,  of  course  only  a  physician 
should  prescribe  it. 

Accessory  Treatment — At  times  any  of  the  following  drugs  may  af- 
ford relief.  Antipyrine,  five  grains  every  three  hours ;  acetanilide  four 
grains  every  three  to  four  hours;  or  the  two  combined,  giving  two  grains 
of  each  every  three  hours ;  or  tbe  tiucture  of  gelsemium  ten  drops  every 
three  to  four  hours,  in  a  teaspoonful  of  water ;  for  reducing  the  fever 
tincture  of  aconite  one  drop  every  hour.  The  following  prescription  is 
often  of  value  in  all  varieties  of  inflammation  of  the  ovary,  irrespective  of 
the  cause: 

R. — Tincture  of  gelsemium 2  drachms 

Tincture  of  cannabis  indica  2  drachms 

Peppermint    water    3  ounces 

One  teaspoonful,  repeat  in  two  hours,  then  every  three  hours. 

When  the  inflammation  becomes  chronic,  local  treatments  should  be 
persevered  in  for  several  weeks;  combined  with  hot  vaginal  injections. 
If  there  be  leucorrhea  use  the  remedies  advocated  under  that  heading. 

If  the  local  treatments  do  not  aff'ord  relief  then  it  will  be  necessary 
to  have  an  ojieration,  which  Avill  consist  in  removing  the  ovary  if  badly 
diseased,  or  if  slightly  so  then  only  that  portion  wluV-h  is  affected. 

Pyosalpinx. — If  an   acute   attack  of  ovaritis   does  not  get  well,  or 


TDMOBS   OF    THE   OVAET.  6G9 

develojis  into  a  cbronic  condition,  and  pus  forms,  then  it  is  called  pyosal- 
pinx,  which  means  pus  in  the  tube  or  oviduct. 

Symptoms — They  will  be  those  of  ovaritis,  only  more  so.  Chills  may 
also  be  present,  due  to  the  absorption  of  the  poisonous  material  from  the 
pus. 

Treatment. — This  consists  in  the  removal  of  the  ovary  and  tube,  as 
no  other  procedure  will  effect  a  cure.  Too  often  women  suffering  from  this 
condition  will  delay  operation  until  the  last  possible  moment,  which  delay 
invariably  costs  their  life. 

ODisplacement  of  the  Ovary — The  ovary  may  drop  down  from  its 
normal  position,  in  so  doing  it  always  falls  back  of  the  womb.  This  is 
called  prolapsus  of  the  ovary. 

Prolapsus  of  the  Ovary — Causes — Generally  due  to  enlargement  of 
the  ovary,  which  may  be  caused  by  inflammation  or  tumors.  A  sudden 
fall  or  misstep  will  at  times  cause  an  ovary  of  normal  size  to  fall  down- 
ward, which  Avill  invariably  become  inflamed. 

Symptoms. — Pain  located  deeji  down  in  the  pelvis,  which  may  be  of  a 
dull  aching  character,  or  sharp  and  shooting.  The  bowel  movements  are 
frequently  painful,  due  to  the  distended  rectum  pressing  against  the  ovary. 
Intercourse  is  very  painful  and  may  be  accompanied  by  nausea. 

Treatment. — Local  treatments  and  the  use  of  the  hot  vaginal  douche 
may  afford  some  relief,  but  invariably  it  is  necessary  to  remove  the  ovary, 
which  operation  will  require  a  rest  in  bed  of  three  to  four  weeks. 

TUMORS  OF  THE  OVARY. 

The  tumors  of  the  ovary  may  be  solid  or  cystic.  The  former  may  be 
benign  or  malignant.  The  solid  tumors  are  divided  into  the  fibrous,  mus- 
cular and  cancerous,  the  latter  of  which  is  extremely  rare. 

Cystic  Tumors  of  the  Ovary — These  cysts  are  divided  in  the  small 
and  large.  The  former  attain  tlie  size  of  an  egg  or  the  fist,  while  the 
latter  may  grow  to  any  size,  holding  many  gallons  of  liquid. 

Causes The  immediate  cause  is  very  obscTire ;  usually  due  to  inflam- 
mation of  the  ovary,  sudden  amenorrhea,  excessive  intercourse  and  blows 
on  the  abdomen.  These  tumors  may  be  present  at  any  age,  from  infancy 
to  advanced  old  age,  but  are  most  common  during  the  period  of  sexual 
activity,  between  the  twentieth  and  fortieth  years.  Strange  to  say  they 
are  most  frequent  in  the  unmarried  woman  and  those  who  have  not  borne 
children. 


670  DISEASES   rECULIiUt   TO   -WOMEN. 

Symptoms. — 1.  The  womau  may  first  notice  that  one  side  of  the 
abdomen  is  larger  than  the  other,  and  later  on  will  be  able  to  feel  a  lump 
on  that  side.  This  may  increase  rapidly  in  size,  the  whole  abdomen 
becoming  distended,  and  looking  not  unlike  pregnancy.  Indeed,  the 
woman  herself  may  suspect  that  she  is  pregnant.  Later  on,  there  will  be 
a  sensation  of  weight  in  the  pelvis,  the  bowel  movements  will  be  painful 
and  the  bladder  very  irritable,  due  to  the  pressure  of  the  tumor.  Painful 
and  profuse  menstruation  is  of  frequent  occurrence. 

2.  As  the  tumor  increases  in  size  there  will  be  pressure  symptoms, 
swelling  of  the  legs,  due  to  pressure  on  the  blood-vessels,  the  privates  may 
become  swollen,  due  to  the  pressure  on  their  blood  supply ;  when  the  tumor 
becomes  sufficiently  large  to  press  on  or  near  the  diaphragm  there  will 
occur  shortness  of  breath.  Besides  these  the  face  will  have  a  pinched 
expression,  characteristic  of  this  kind  of  tumor;  there  will  be  marked  loss 
of  weight  and  general  debility. 

3.  Pain  more  or  less  constant  will  be  present,  and  at  times  violent 
in  character.  This  may  be  due  to  peritonitis,  caused  by  the  irritation  of 
the  tumor. 

Treatment. — 1.  The  only  cure  is,  of  course,  operation.  If  the  cysts 
are  very  small,  about  the  size  of  a  pea,  they  can  be  removed  from  the 
ovary,  and  this  organ  allowed  to  remain.  But,  on  the  other  hand,  if  they 
are  the  size  of  a  pigeon's  egg  or  larger,  then  it  will  be  necessary  to  re- 
move the  ovary  with  the  tumor. 

2.  The  old  method  of  tapping  the  cyst  and  drawing  off  its  contents 
is  to  be  condemned  as  dangerous. 

3.  The  operation  of  ovariotomy,  or  removal  of  the  ovary,  will  neces- 
sitate the  patient  remaining  in  bed  three  to  four  weeks. 

lACERATIONS  OF  THE  PERINEUM. 

Character.— This  consists  of  tears  of  the  anterior  and  posterior  walls 
of  the  vagina,  during  childbirth.  The  laceration  may  extend  through  the 
posterior  vaginal  wall  into  the  perineal  body. 

Symptoms. — 1.  "When  the  anterior  or  front  wall  of  the  vagina  becomes 
torn  the  support  of  the  bladder  is  iisually  disturbed,  and  there  will  be 
more  or  less  trouble  in  voiding  urine.  In  addition  there  will  be  an  in- 
ability to  entirely  empty  the  bladder  each  time,  which  may  result  in  in- 
flammation of  the  bladder. 

2.  When   the    posterior   or   back   wall   of    the    vagina    is   torn   the 


QONOKKHEA.  671 

symptoms  are  more  marked.  This  laceration  as  a  rule  extends  through 
the  muscle  which  is  the  main  sup^jort  of  the  womb  from  below,  by  holding 
up  the  fielvic  floor,  and  in  this  way  supporting  the  womb.  These  m.useles 
are  two  in  number,  one  ou  either  side. 

Treatment. — 1.  After  labor  the  parts  should  be  thoroughly  inspected 
to  see  if  a  laceration  has  occurred.  If  so  it  should  be  sewed  up  at  the  time. 
When  a  physician  tells  a  woman  that  she  is  torn — and  it  is  no  fault  of  his 
that  such  does  happen— and  desires  to  insert  stitches,  she  should  allow  him 
to  do  so.  Too  often  women  will  not  permit  it,  and  they  regret  it  only  once, 
and  that  is  as  long  as  they  live. 

2.  If  the  tears  are  sewed  right  after  the  baby  is  born  they  will  in- 
variably heal  and  the  parts  will  be  restored  to  the  same  condition  they 
were  in  prior  to  labor.  If  not  the  muscles  and  tissues  do  not  heal  together, 
and  the  woman  will  begin  to  suffer  from  all  kinds  of  pelvic  symptoms, 
such  as  forward  and  backward  displacements  of  the  womb,  prolapse  of  this 
organ,  prolapse  of  the  bladder  and  obstinate  constipation. 

3.  These  lacerations  are  divided  into  complete  and  incomplete.  The 
first  consists  of  those  in  which  the  tear  extends  through  the  bowel,  the 
latter  a  tear  of  any  extent  near,  or  down  to,  but  not  through  the  bowel.  If 
these  lacerations  are  not  repaired  at  the  time,  then  it  will  only  be  a  ques- 
tion of  time  before  such  an  operation  will  be  necessary,  so  why  not  permit 
the  physician  to  do  as  he  thinks  best  at  the  time  these  lacerations  occur. 

4.  If  the  laceration  is  complete  there  will  be  a  loss  of  control  of  the 
bowels,  and  they  will  move  without  the  knowledge  of  the  woman.     If  the^ 
tears  are  not  repaired  at  the  time,  it  is  useless  to  attempt  it  less  than 
three  months  after  labor,  if  so  a  poor  result  will  usually  be  obtained. 

GOIfORRHEA. 

Character. — This  is  an  inflammatory  disease  commonly  called  "the 
clap."  Greater  than  any  other  danger,  presented  to  woman,  is  sexual  in- 
tercourse with  a  man  who  has  gonorrhea  or  syphilis;  the  former  is  the 
more  destructive.  The  attack  of  gonorrhea  in  the  male  at  the  time  of 
intercourse  may  be  acute,  chronic,  or  one  which  had  not  been  thoroughly 
cured. 

A  Serious  Disease While  gonorrhea  in  man  in  most  cases  is  a  trifling 

disorder,  although  there  are  exceptions  in  which  it  leaves  a  serious  con- 
dition or  becomes  fatal,  are  not  so  very  rare;  in  woman  it  is  one  of  the 
most  serious  diseases. 


j672  DISEASES    PECULIAR    TO    WOMEN. 

Many  an  innocent  and  previously  healthy  woman,  shortly  after  mar- 
riage to  a  man  who  siij)posed  himself  to  have  heen  cured  of  gonorrhea 
years  before,  may  get  a  destructive  gonorrheal  infection. 

Diseases  Induced  by  Gonorrhea. — When  we  take  into  consideration 
that  a  gonorrheal  infection  in  a  woman  may  cause  inflammation  of  the 
vulva,  vagiua,  urethra,  bladder,  lining  membrane  of  the  womb,  the  womb 
itself,  the  tubes  and  the  ovaries;  that  the  inflammation  of  the  tubes  and 
ovaries  as  a  rule  result  in  abscesses,  nay  more,  that  too  often  both  ovaries 
have  to  be  removed,  and  oftentimes  the  womb  with  it,  then  you  will  realize 
the  dangers  of  an  attack  of  this  disease  in  a  woman. 

Causes. — They  have  been  mentioned,  intercourse  with  a  man  who  has 
had  an  attack  of  gonorrhea,  or  is  still  suffering  from  an  old  attack  which 
has  not  been  thoroughly  cured,  and  yet  his  physician  has  probably  dis- 
charged him  as  "cured."  Very  frequently  you  will  hear  a  person  say 
that  it  was  contracted  from  a  water  closet;  this  is  impossible,  especially 
with  a  man,  but,  a  woman,  under  very  rare  circumstances,  may  come  in 
contact  with  pus  which  has  escaped  from  the  male  on  to  the  seat  of  the 
closet.  I  have  never  heard  of  such  an  instance  happening;  although  it 
is  possible  it  is  extremely  improbable. 

Symptoms. — 1.  These  consist  first,  of  a  burning  and  itching  sensation 
in  the  '"privates,"  followed  in  a  day  or  two  by  a  discharge,  which  in  a  few 
days  generally  becomes  profuse.  The  pain  in  these  parts  then  becomes 
more  or  less  unbearable.  Each  time  the  bladder  is  emptied  there  is  a 
"burning,  scalding  sensation,  due  to  the  urine  flowing  over  the  inflamed 
jiarts. 

2.  If  the  inflammation  spreads  to  the  urethra  and  bladder  there  will 
te  all  the  symptoms  of  cystitis  (which  see).  If  the  disease  extends  to  the 
uterus  there  will  be  all  the  symptoms  of  acute  inflammation  of  the  womb, 
which  will  necessitate  the  woman  going  to  bed.  As  the  disease  spreads  to 
the  tubes  and  ovaries  the  pain  in  the  lower  part  of  the  abdomen  will 
become  intense  and  the  fever  increase ;  both  of  which  will  become  intensi- 
fied if  abscesses  form. 

Treatment — This  consists  in  vaginal  injections  of  permanganate  of 
potash,  five  grains  to  a  quart  of  hot  water  four  times  daily ;  bichloride  of 
mercury,  seven  and  one-half  grains  to  the  quart,  same  as  before ;  or  appli- 
cations to  the  vagina  of  nitrate  of  silver,  thirty  to  forty  gi-ains  to  the 
ounce  of  water.  The  latter  should  be  done  by  a  physician.  A  woman 
who  has  the  symptoms  first  mentioned  may  at  once  suspect  she  has  gonor- 


DISEASES  OF  THE  BLADDER.  673 

rhea,  and  should  consult  a  physician  immediately  and  place  herself  under 
his  care. 

DISEASES  OF  THE  BLADDER. 

The  bladder  may  be  irritable  and  yet  not  inflamed,  so  a  special  de- 
scription will  be  made. 

Irritability  of  the  Bladder. — This  may  arise  from  purely  functional 
causes  and  is  of  frequent  occurrence  in  nervous  women.  Oftentimes 
present  in  diseases  of  the  womb  and  vagina,  and  when  the  front  wall  of 
the  vagina  has  been  lacerated.  Also  present  in  displacements  of  the 
womb.     It  may  follow  abdominal  operations  and  parturition  fchildl)irth). 

Symptoms. — Similar  to  those  of  cystitis.  The  urine  from  an  irritaltle 
bladder  is  always  clear,  never  contains  pus. 

Treatment. — Build  up  the  constitution  by  the  use  of  tonics.  (See 
(Anemia.)     Eegidate  the  bowels.     The  following  may  be  tried: 

R. — Atropine   sulphate    '/j  grain 

Distilled    water    4  ounces 

Five  drops  in  water  ifter  meals. 
If  the  woman  is  extremely  nervous,  fifteen  grains  of  the  bromide  of  potassium 
or  sodium  every  four  hours  will  prove  of  value. 

Cystitis. — This  is  an  inflammation  of  the  mucous  membrane  of  the 
bladder  and  may  be  acute  or  chronic. 

Causes. — Acute  cystitis  may  be  caused  by  exposure  to  cold;  gonor- 
rhea; dirty  instruments,  particularly  a  catheter;  pressure  of  the  child 
during  labor;  inflammation  of  the  peritoneum  or  pelvic  organs;  blows 
and  falls  when  the  bladder  is  distended  with  urine,  and  the  improper  use 
of  certain  drugs. 

Chronic  cystitis  may  be  a  continuation  of  the  acute  form,  especially 
by  pressure  of  the  uterus  during  pregnancy,  or  large  tumors. 

Symptoms. — 1.  The  acute  form  frequently  begins  with  a  chill,  fol- 
lowed by  fever,  which  is  not  very  high.  There  is  considerable  pain  in 
the  lower  portion  of  the  abdomen,  difhcult  and  painful  urination,  and  the 
urine  is  very  cloudy.  The  desire  to  urinate  at  night  may  be  very  trouble- 
some, and  is  apt  to  become  more  or  less  constant.  There  is  a  continuous 
feeling  of  pressure  and  weight  over  the  bladder. 

2.  In  the  chronic  condition  the  pain  is  not  so  severe,  but  constant 
desire  to  pass  water,  especially  at  night,  is  very  distressing.  When  there 
■w  a  desire  to  pass  water  the  patient  must  go  at  once,  being  unable  to  hold 
(43. 


674  DISEASES   PEOCLIAR    TO    WOMEN. 

her  water.  If  she  shouUl  lift,  heavy  weights  or  cough  tlie  water  va&y 
dribble  away. 

Treatment. — 1.  All  instriiments  that  are  introduced  into  the  bladder 
should  be  thoroughly  cleansed  and  rendered  antiseptic. 

The  acute  form  is  best  treated  by  rest  in  bed  and  an  ice  bag  over  the 
bladder.  If  the  latter  is  not  tolerated,  then  try  a  hot  water  bag.  A  very 
good  drink  is  flaxseed  tea.  If  the  pain  is  severe,  one-half  grain  of  opium 
suppository  will  afford  relief,  repeating  in  about  three  hours  if  necessary. 
The  following  prescription  will  be  found  very  useful: 

R. — Tincture    of   aconite    I  drachm 

Sweet  spirits  of  nitre   I  ounce 

Liquor  potassii  citratis   6  ounces 

A  dessertspoonful  every  four  hours. 

All  alcoholic  liquors  must  be  restricted,  and  the  diet  should  consist  of 
milk  and  broths. 

2.  If  the  disease  becomes  chronic  the  patient  should  be  kept  on  a 
bland  diet.  Vegetables,  such  as  asparagus  and  those  containing  salts,  and 
all  alcoholic  liquors  should  be  prohibited. 

3.  If  the  urine  is  highly  acid  it  should  be  rendered  neutral  by  the 
benzoate  of  sodium ;  if  it  is  alkaline,  it  should  be  rendered  less  irritating 
by  the  acetate  or  citrate  of  potassitun. 

4.  Salol,  five  grains,  four  times  a  day  is  an  excellent  drug  for  this 
condition.  Mineral  waters  sitch  as  Bethesda,  Vichy  and  Buffalo  Lithia 
are  to  be  taken,  at  least  several  glassfuls  a  day. 

5.  Great  relief  is  afforded  by  washing  out  the  bladder,  of  course  this 
can  be  done  only  by  a  physician. 

6.  If  the  water  constantly  dribbles  away,  it  may  be  cured  by  stretch- 
ing the  neck  of  the  bladder.  This  will  necessitate  remaining  in  bed  for 
about  a  week. 

Stone — Stone  in  the  bladder  of  course  requires  an  operation  for  its 
removal.  There  is  a  prevalent  idea  that  a  stone  in  the  bladder  can  be  dis- 
solved by  medicines  and  lithia  water.  This  is  a  false  impression  and  a 
great  many  quacks  take  advantage  of  it,  generally  to  extort  money  from 
the  sufferer. 


DISEASES  OF  THE  FEMALE  BKEAST.  675 

DISEASES  OF  THE  FEMALE  BREAST 

The  breast  is  subject  to  inflammation,  abscesses  and  tumors. 
MASTITIS  OR  MAMMITIS,  INFIAMMATION  OF  THE  BREAST. 

Causes — This  may  be  produced  by  blows  on  the  breast,  or  to  any  of 
the  usual  causes  of  inflammation.  It  may  occur  at  any  age,  and  in  either 
sex.  An  acute  attack  is  more  often  found  present  in  nursing  women  dur- 
ing the  first  week  or  month  after  delivery.  If  such  happens  it  is  in- 
variably due  to  >  cracked  nipples. 

Symptoms — At  first  only  an  uneasiness  of  the  breast  Is  noticed,  then 
a  chill  occurs  which  is  usually  followed  by  fever.  The  gland  becomes 
intensely  swollen,  red  and  exceedingly  painful.  The  inflammation  may 
be  so  great  as  to  cause  an  abscess. 

Treatment — This  consists  in  preventing  an  abscess  from  forming. 
To  accomplish  this  wash  the  nipples  thoroughly  three  to  four  times  a  day, 
and  stop  the  baby  nursing  the  affected  breast.  The  breast  should  be 
emptied  of  milk,  by  the  cautious  use  of  the  breast  pump.  Cloths  saturated 
in  a  solution  of  lead  water  and  laudaniim  should  be  applied  several  times 
a  day,  and  over  these  lay  an  ice  bag,  or  rub  frequently  with  hot  lard. 

ABSCESS  OF  THE  BREAST. 

If  the  inflammation  does  not  subside  an  abscess  invariably  resiilts.' 
Treatment. — 1.  If  It  appears  that  piis  is  forming  hot  applications 

should  be  made,  preferably  flaxseed  poultices,  to  be  renewed  as  soon  as 

they  become  cooled. 

2.  As  soon  as  pus  is  detected  the  breast  should  be  incised  and  the 
cavity  drained. 

3.  Too  often  women  refuse  to  allow  their  physician  to  lance  the 
breast,  thinking  it  will  come  to  a  head  and  be  well  In  a  few  days.  This  is 
a  great  mistake.  The  breast  should  be  freely  opened,  in  order  that  the  pus 
can  easily  run  out.  If  necessary  an  anesthetic  should  be  taken,  In  order 
that  the  physician  may  accomplish  thorough  work.  At  times  It  may  be 
necessary  to  insert  a  drainage  tube;  depending  entirely  upon  the  time 
which  has  elapsed  from  the  formation  of  the  pus  until  the  time  It  is 
incised. 


6Y6 


DISEASES    I'JiCULIAit   TO   WOMKN. 


TUMORS  OF  THE  BREAST. 


These  may  he  benigii  or  malignant.  Tumors  of  the  former  type  can 
be  readily  removed,  and  will  not  give  rise  to  further  trouble.  On  the 
other  hand,  those  of  the  latter  class,  which  are  of  a  cancerous  nature,  are 
very  ajit  to  return,  unless  operated  on  early  and  thoroughly. 

CANCER  OF  THE  BREAST. 

Character. — Very  often  a  woman  will  strike  her  breast  against  a  hard 
object,  or  may  be  struck  by  a  fist.  This  blow  may  be  followed  by  a  luiaji, 
which  in  a  few  days  may  disappear.  i 

Again,  a  woman  while  dressing  may  notice  a  lump  in  the  breast,  and 
think  nothing  further  about  it,  or  may  try  to  cure  it  by  rubbing  in 
camphorated  oil,  or  other  household  liniments. 

These  lumps  frequently  are  the  early  stages  of  cancer,  and  the  longer 
the  delay  the  greater  the  risk.  When  a  woman  discovers  a  lump  in  the 
breast  she  should  consult  a  physician  at  once  in  order  that  he  may  properly 
treat  and  watch  it.  If  the  lump  continues  to  grow  and  remains  hard  then 
he  will,  or  rather  should,  advise  an  operation.  Under  sucb  circumstances 
these  lumps  are  invariably  a  beginning  cancer. 

Treatment. — If  the  lump  is  small  then  it  may  not  be  necessary  to 
remove  the  entire  muscles,  but  simply  the  breast.  On  the  other  hand,  if 
the  lump  is  large  and  of  long  standing,  or  if  the  breast  is  immovable,  that 
is,  cannot  be  moved  from  side  to  side,  then  the  breast,  muscles  and  all  sur- 
roimding  tissue  will  demand  removal.  Kccurrence  may  follow.  Many 
women  can  be  cured  of  cancer  of  the  breast,  providing  they  will  consult  a 
good  physician  early,  which  is,  as  soon  as  a  lump  is  noticed ;  and  if  such 
does  not  become  smaller  or  disappear  in  two  weeks,  submit  at  once  to  an 
operation  or  the  application  of  the  X-ray. 

Beware  of  Quacks. — It  is  surprising  the  number  of  women  who  will 
scorn  the  advice  of  a  physician,  and  place  themselves  under  the  care  of  a 
charlatan  or  a  quack.  This  class  has  killed  more  women  than  any  of  the 
most  malignant  of  diseases,  and  yet  the  State  will  sanction  their  existence. 
Beware  of  quacks,  especially  when  a  cancer  exists.  These  deceivers  and 
money  extortionists  advertise  to  remove  these  growths  by  the  "roots." 
Such  growths  have  no  roots.  And  yet  how  many  women  will  stand  the 
torture  of  the  acids  which  they  apply  to  eat  out  the  tumor,  in  preference 
to  a  clean-cut  operation,  imder  an  anesthetic,  which  will  keep  them  in  bed 


FACTS  OF  GEEAT  VALUE  TO  WOME^.  CTT 

only  two  weeks.      While  the   "eating  out  the  roots"   process   reijuires   a 
torture  of  several  weeks. 


SOME  INTERESTING  FACTS  OF  GREAT  VALUE  TO  WOMEN 

Preventing:  Disease — Education  has  a  great  influence  in  the  develop- 
ment of  diseases  peculiar  to  women.  During  early  childhood,  when  the 
pelvic  organs  are  undergoing  their  development,  the  child  must  not  be 
confined  to  the  house  and  at  school  all  day.  She  should  be  allowed  as 
many  hours  recreation  a  day  as  feasible,  in  order  that  she  may  enjoy 
out-door  exercise,  and  obtain  all  the  fresh  air  possible,  which  is  of  so 
vital  importance  to  her  constitution.  Too  long  daily  practice  at  the  piano 
or  organ  is  also  harmful. 

What  to  Avoid. — Everything  that  causes  an  increase  of  blood  to  the 
womb  and  ovaries  should  be  avoided.  In  this  category  belong  sexual 
excitement  brought  on  by  reading  suggestive  novels;  by  looking  at  ob- 
scene pictures ;  by  masturbation  (self-abuse)  ;  sodomy  and  even  normal 
coition  if  performed  too  violently. 

Care  of  the  Skin — The  care  of  the  skin  is  of  great  importance.  Baths, 
daily  or  two  or  three  times  a  week,  should  be  encouraged.  The  accumu- 
lation of  dirt  blocks  up  the  sweat  glands,  and  nature  is  unable  to  throw 
off  the  impurities  through  these  vessels.  The  Jewesses  from  Eussian 
Poland  are  very  susceptible  to  disease,  and  their  appearance  conveys  to 
one  the  idea  that  they  never  wash  their  bodies. 

Overwork. — All  work  and  no  play  is  a  fruitful  cause  of  ill  health. 
Every  woman  who  has  the  cares  of  a  household  should  indulge  in  open- 
air  exercise,  or  daily  walks.  Golf,  horseback  riding,  walks,  gathering 
flowers  and  the  like,  are  to  be  highly  commended,  because  they  combine 
exercise  with  open  air. 

Proper  Food. — There  is  room  for  improvement  regarding  food. 
Many  girls  have  a  loathing  for  food  in  the  morning,  and  often  take  noth- 
ing but  a  cup  of  coffee,  and  at  times  not  even  that,  and  go  to  school,  and 
allow  their  brains  to  work  for  hours  on  an  empty  stomach.  Such  a 
practice  is  to  be  condemned  in  the  strongest  terms.  It  is  not  only  a 
very  bad  habit,  but  it  sjioils  the  appetite,  tends  to  cause  a  sour  stomach, 
and  impoverishes  the  blood,  which  leads  to  nervous  disturbances.  The 
same  may  be  said  of  candy,  the  immoderate  use  of  which  among  girls 
and  women  corresponds  to  alcoholic  beverages  and  tobacco  in  men. 

Uode   of  Dressing — Some  few  suggestions   regarding  the   mode   of 


678  DISEASES   PECULIAR   TO    WOMEN. 

dressing  may  be  of  value.  One  of  the  most  frequent  causes  of  congestion 
of  the  pelvis  is  the  ''decollete"  evening  dress  and  the  bell-shaped  nether 
garments.  High  heels,  when  worn  at  an  early  age  are  apt  to  change  the 
normal  inclination  of  the  pelvis,  a  cause  of  tedious  and  difficult  labors. 

Tight  Lacing — Of  much  more  importance  is  the  use  of  the  corset. 
A  loose  corset  at  the  best  is  more  or  less  binding.  Tight  lacing,  of  course, 
should  be  avoided,  it  displaces  the  various  organs  in  the  abdomen,  push- 
ing them  in  all  directions,  excepting  the  normal,  and  causes  a  crowding 
down  of  the  pelvic  organs,  hence  a  fruitful  cause  of  diseases  of  women. 

The  Menstrual  Period — JS^eo-lect  during  menstruation  is  one  of  the 
most  fruitful  causes  of  female  diseases.  Dancing  and  skating  during  this 
period  should  not  be  permitted.  Sexiuxl  intercourse  at  this  time,  to  say 
the  least,  is  a  repulsive  habit,  yet  it  is  not  of  rare  occurrence.  Such  a 
practice  is  very  apt  to  result  in  a  pyosalpinx  (abscess  of  the  oviduct,  which 
see). 

Marriage  with  Disease. — Marriage  with  existing  disease  of  the  pelvic 
organs  is  a  frequent  cause  of  unhappiness  for  both  husband  and  wife. 
Disease  of  such  organs  may  jirove  destructive  of  all  sexual  desire  or  may 
prevent  the  possibility  of  conception.  But  if  these  should  not  ensue,  there 
still  remains  the  greater  and  more  appalling  danger  of  defective  child  de- 
velopment in  the  womb,  or  of  the  actual  transmission  of  disease  to  off- 
spring. Such  calamities  are  all  too  frequent,  and  those  who  would  enter 
the  marriage  estate  should  feel  certain  that  their  pelvic  organs  are  free 
from   diseased   conditions. 

Evil  of  Abortions — Abortions,  however  brought  about,  play  their  part 
in  causing  inflammatory  and  nervous  wrecks  of  women.  They  are  the 
source  of  many  serious  and,  ofttimes,  permanent  diseases.  Causes  of  abor- 
tion are  very  numerous.  Among  those  most  common  are  displacement  of 
the  womb,  ulceration  of  the  neck  of  the  womb,  too  much  exercise,  heavy 
lifting,  jar  from  a  slip  or  fall,  strong  emetics,  powerful  purging,  etc. 

Treatment  of  Abortion If  the  symptoms  are  slight,  it  may  be  that 

nothing  more  than  a  few  days'  rest  will  bo  required,  keeping  the  body  as 
much  as  possible  in  a  horizontal  position,  taking  occasional  cooling  drinks, 
and  at  bedtime  a  jiill  comj^osed  of  one  grain  of  camphor  and  two  grains 
of  sugar  of  lead.  In  addition,  a  mustard  plaster  may  be  applied  to  the 
lower  part  of  the  back  to  allay  any  pain  that  may  be  experienced.  If  the 
conditions  are  severe,  and  flooding  should  set  in,  accompanied  with  marked 
symptoms  of  miscarriage,  a  napkin  wetted  with  cold  water,  or  vinegar  and 
water,  should  be  laid  upon  the  external  genitals.    Rest  in  bed  is  important. 


CHANGE  OF  LIFE    (mENOPAUSk),  679 

If  the  symptoms  are  not  thus  allayed,  recourse  mnst  be  had  to  the  plug- 
ging of  the  vagina  with  pieces  of  cloths  soaked  in  a  solution  of  alum  or 
tannin;  fill  the  vagina  full  and  then  place  a  fold  of  linen  in  the  genital 
fissure  and  apply  a  bandage.  Remove  the  plug  in  from  five  to  ten  hours, 
and  replace  if  the  discharge  continues. 

Conception — Every  young  couple  intending  to  enter  the  marriage 
relation  should  know  what  a  terrible  curse  they  are  liable  to  transmit  to 
their  future  children  through  ignorance  of  the  vital  principles  which  regu- 
late reproduction.  This  attended  to,  it  then  remains  with  the  mother  to 
mold  the  infant  growing  within  her  by  being  herself  at  the  time  what  she 
would  like  her  child  to  be. 

The  physical  obstacles  to  conception  are  chiefly  those  diseases  which 
have  been  previously  described.  When  it  is  dependent  on  the  causes  which 
produce  painful  menstruation,  or  profuse  menstruation,  or  a  suppression 
of  menstruation,  the  remedies  are  the  same  as  are  pointed  out  for  those 
complaints.  If  inflammation  of  the  ovaries  be  the  cause,  a  cure  may  be 
effected,  provided  the  inflamed  condition  be  removed.  If  inflammation  or 
ulceration  of  the  neck  of  the  womb  be  the  obstacle,  the  remedy  may  be 
found  in  the  treatment  reconrmended  for  these  affections. 

CHANGE  OF  LIFE  (MENOPAUSE). 

This  is  better  known  as  the  "change  of  life,"  also  called  the  cll- 
matcric. 

Time  and  Character — It  comes  on  gradually,  extending  over  a  period 
of  three  to  four  years;  it  comprises  the  times  when  the  monthly  flow 
begins  to  be  irregular,  gradually  diminishes  and  ceases  altogether.  As 
a  rule  in  most  women  it  begins  about  the  age  of  forty-five,  but  invari- 
ably so  between  forty-five  and  fifty  years.  Those  who  menstruate  early 
continue  to  menstruate  longer  than  those  who  begin  late,  hence  have  a 
late  menojjause.  Those  who  suffer  from  a  chronic  inflammation  of  the 
womb  or  are  weakened  by  severe  uterine  hemorrhages  begin  to  change 
life  sooner  than  a  healthy  woman. 

When  the  menopause  comes  on  gradually  the  woman  is  not  very 
liable  to  have  severe  xlisturbances,  but  if  it  comes  on  abruptly  the  dis- 
comforts are  very  bad,  and  the  general  strain  of  symptoms  are  marked. 

Dangers  of  the  Period. — This  period  is  a  critical  point  of  a  woman's 
life.  Too  often  women  while  passing  through  this  stage  pay  little  atten- 
tion to  it,  and  every  bad  symptom  is  attributed  to  the  "change  of  life." 


680  DISEASES   I'ECULIAU   TO    WOMEN. 

This  is  tlie  time  of  all  others  that  cancer  of  the  womb  ami  breasts  are 
prone  to  develop.  Every  woman  with  a  lunqi  in  her  breast,  which  de- 
velops during  this  period,  should  consult  a  physician  at  once.  When- 
ever bleeding-  takes  place  from  the  vagina,  after  the  nienopause  has  ended, 
invariably  signifies  beginning  cancer,  and  the  woman  should  immediately 
submit  to  an  cxa77iination. 

Symptoms. — 1.  The  first  symptom  of  the  menopause  is  irregularity  in 
the  menstrual  flow,  as  regards  the  time  and  quantity.  The  intervals  be- 
tween the  menstrual  periods  will  become  extended,  say  every  five  to  six, 
seven  or  eight  weeks.  Sometimes,  on  the  contrary,  menstruation  becomes 
more  frequent.  The  periods  last  longer,  say  six  to  eight  days.  There 
will  be  congestion  of  the  head,  causing  a  red  face,  headache  and  indistinct 
vision,  buzzing  in  the  head  and  ears,  dizziness,  the  sleep  is  disturbed  by 
dreams,  and  at  the  time  the  flow  should  occur  may  have  bleeding  of  the 
nose. 

2.  Besides  the  above,  there  may  be  catarrh  of  the  stomach,  and  in- 
testines; congestion  of  the  liver,  rendering  it  torpid;  the  kidney  disturb- 
ances generally  appear  in  the  form  of  a  sediment  in  the  urine.  Leu- 
corrhea  may  be  very  troublesome.  An  eruption  of  the  skin  of  the  face 
may  occur,  and  there  may  be  intense  itching,  burning  or  smarting  sensa- 
tions all  over  the  body.  The  vulva  may  be  the  seat  of  most  distressing 
itching. 

3.  A  very  disagreeable  feature  of  the  "change"  is  the  fever  and 
sweats;  this  consists  in  a  rush  of  blood  to  the  head,  the  body  becomes 
very  warm  and  then  breaks  out  into  profuse  perspiration.  This  may 
occur  at  any  time  and  place.  When  others  think  the  room  very  cool,  she 
will  think  it  exceedingly  warm. 

4.  The  heart  is  often  affected  in  the  form  of  palpitations  and  short- 
ness of  breath.  The  nervous  system  also  shows  evidences  of  a  general 
upset.  Sometimes  the  limbs  become  very  trembly.  The  temper  is  sub- 
ject to  great  changes,  and  the  sexual  appetite  may  be  greatly  increased. 
She  may  become  delirious,  or  even  go  insane. 

5.  The  organs  of  generation  undergo  marked  changes.  The  uterus, 
vagina,  vulva,  ovaries  and  breast  all  shrink  and  become  greatly  reduced 
in  size. 

Treatment. — 1.  Although  this  is  a  perfectly  natural  process,  which  is 
of  normal  occurrence  in  every  woman's  life,  conditions  will  arise  demand- 
ing interference. 

Above  all  keep  the  bowels  open.     For  the  sediment  in  the  urine  it  is 


ABOETION.  681 

well  to  driiik;  Vichy  or  Seltzer  water  freely  during  the  day ;  or  to  take  half 
a  teaspoonfiil  of  hicarbonate  of  soda  in  a  tumblerful  of  water  in  the  course 
of  the  day. 

2.  The  congestion  of  the  head  and  the  disturbances  of  vision  are  re- 
lieved by  hot  footbaths,  with  or  without  mustard,  and  of  the  cold  water 
eye  douche  five  minutes  three  times  daily. 

3.  Lukewarm  general  bath  taken  three  times  a  week  will  keep  the 
skin  in  good  condition,  which  is  of  value. 

4.  Those  women  who  have  a  tendency  to  stoutness  should  adhere  to 
a  restricted  diet,  such  as  fish,  meat,  green  vegetables,  lettuce,  salad  and 
juicy  fruits.     Milk  and  beer  are  prohibited. 

5.  The  few  women  who  lose  ilesh  must  be  well  fed,  and  have  choco- 
late and  plenty  of  milk  to  drink,  providing  they  can  digest  them. 

G.  A  sudden  suppression  of  the  flow  during  this  period  is  jiarticularly 
dangerous,  hence-  she  should  avoid  getting  the  feet  wet,  wet  skin,  and 
should  not  take  a  cold  bath  nor  wash  the  privates  with  cold  water.  All 
these  refer  to  when  the  menses  are  present. 

7.  If  hemorrhages  occur  employ  the  remedies  advocated  for  the 
treatment  of  menorrhagia  and  metrorrhagia. 

8.  If  the  bleeding  is  quite  profuse,  pack  clean  pieces  of  linen  tightly 
in  the  vagina,  and  allow  them  to  remain  imtil  a  physician  is  consulted, 
which  should  be  immediately.  This  method  of  packing  the  vagina  will 
control  the  bleeding  until  the  physician  arrives  and  institutes  more  radical 
measures.  A  good  uterine  tonic  such  as  the  pil  uter  ova  often  does  much 
to  relieve  the  nervous  condition  and  allay  pain  and  distress. 

MISCAKRIAGE  OR  ABORTION. 

Meaning^. — Abortion  is  the  expulsion  of  the  product  of  conception 
from  the  womb.  It  is  also  called  miscarriage,  by  which  name  it  is  better 
known.  Amongst  the  laity  at  large  the  term  miscarriage  is  generally  used 
when  this  accident  happens  without  any  violence  on  the  part  of  the  mother, 
whereas  abortion  is  applied  when  attempts  have  been  made  to  bring  on 
this  condition  by  the  introduction  into  the  womb  of  instruments. 

Divisions Abortion  has  been  divided  into  spontaneous  or  natural 

and  accidentah  A  better  division  is  spontaneous  and  artificial.  The  latter 
class  is  divided  into  therapeutic  and  criminal ;  therapeutic  abortion  is  that 
in  which  it  is  done  by  the  physician  in  the  interest  of  the  mother's  life 
or  health,  while  criminal  abortion  is  without  this  or  any  other  justification. 


6S2  DISEASES    TECnLIAR    TO    WO.MEX. 

It  is  further  divided  into  comiilete  and  incomplete ;  threatened  and  in- 
evitable. 

Complete  Abortion — By  eomi>lete  is  meant  that  all  the  product  of 
conception,  foetus  and  afterbirth,  is  expelled ;  incomplete,  when  only  a  part 
of  it  comes  away,  invariably  the  foetus,  the  afterbirth  or  part  of  it  remain- 
ing in  the  womb ;  when  the  symptoms  of  an  abortion  appear,  and  it  can  be 
checked,  it  is  spoken  of  as  a  threatened  abortion;  whereas,  if  it  is  in- 
evitable, when  in  spite  of  all  that  is  done,  miscarriage  occurs. 

Criminal  Abortions. — The  greater  number  of  miscarriages  occur  in 
the  first  three  months  of  pregnancy.  It  has  been  shown  by  statistics  that 
criminal  abortion  is  more  frequent  from  the  third  to  the  sixth  month  than 
in  the  first  two  months.  The  explanation  of  this  fact  is  due,  that  up  to 
three  months  the  woman  hopes  that  there  is  simjily  a  delay  in  the  appear- 
ance of  the  flow,  but  when  this  hope  fails  she  is  ready  to  resort  to  any  pro- 
cedure to  end  a  pregnancy  which  now  becomes  almost  certain  ;  on  the  other 
hand,  when  six  mouths  have  elapsed  the  life  of  the  child  has  become  so 
manifest  that  she  shrinks  from  its  destruction.  Movements  of  the  foetus 
in  the  womb  make  successful  appeals  to  the  mother's  conscience,  if  not  to 
her  love  also,  for  the  salvation  of  the  new  life  which  dwells  within  her 
womb  as  its  sanctuary. 

Dangers  of  Abortion. — -It  is  surprising  the  number  of  criminal  abor- 
tions that  occur  yearly,  and  which  fail  to  come  to  notice,  unless  the  victim 
dies,  when  an  expose  is  made  by  the  coroner.  And  even  then  many 
women  die  with  the  names  of  the  abortionist  and  her  seducer  sealed  upon 
her  cold  lips.  Women  do  not  for  one  instant  think  of  the  damage  which 
is  wrought  to  their  generative  organs,  when  they  introduce  some  instru- 
ment or  "what  not"  into  the  womb  in  order  "to  open  it,"  so  that  a  mis- 
carriage will  occur.  Inflammations,  displacements  of  the  womb,  and 
pelvic  abscesses,  and  abscesses  of  the  ovaries  too  frequently  follow  these 
foolhardy  attempts.  How  many  women  have  sacrificed  their  lives  in  this 
criminal  and  damnable  manner  ? 

Causes. — 1.  The  causes  of  this  unfortunate  condition  are  numerous, 
they  may  be  due  to  disease  of  the  foetus,  placenta,  womb  or  the  mother. 
Then  again  the  father  may  be  at  fault.  For  instance,  men  who  are  con- 
firmed alcoholics,  or  suffering  from  consumption  or  syi^hilis  will  invariably 
have  a  serious  effect  on  their  offspring,  in  that  if  pregnancy  should  occur 
the  foetus  dies  within  a  month  or  so  after  conception.  Abortion  is  of 
frequent  occurrence  in  the  wives  of  men  who  work  in  lead. 

2.  Violent  exercise,  as  running,  dancing,  jumping,  riding  on  a  hard 


ABOKTION.  683 

trotting  horse  or  over  a  rough  road ;  lifting  heavy  weights,  falls,  blows, 
tight  corsets,  surgical  oiscrations,  especially  if  on  the  organs  of  generation, 
are  very  prone  to  cause  an  abortion.  Frequency  of  intercourse  is  not  an 
unfrequent  cause. 

3.  Among  other  causes  which  may  bo  attributed  to  the  mother,  are 
Infectious  diseases,  such  as  typhoid  fever,  during  which  she  is  very  apt  to 
abort;  syphilis,  this  is  one  of  the  most  frequent  causes;  backward  dis- 
placement of  the  womb  plays  a  very  important  part  in  this  condition ;  a 
pregnant  woman  working  in  a  tobacco  factory  is  very  liable  to  miscarry. 

4.  Again,  violent  sneezing  or  cough  may  be  the  cause.  Tumors  of 
the  womb  and  malignant  disease  of  this  organ  are  also  active  factors; 
though  as  a  rule  a  woman  with  cancer  of  the  womb  rarely  becomes  preg- 
nant, the  same  applies  to  large  fibrous  tumors,  and  the  smaller  when 
located  in  the  cavity  of  the  womb.  High  altitudes  will  also  produce  an 
abortion,  and  it  is  asserted  that  in  certain  mountainous  countries  pregnant 
women  descend  to  the  valleys  to  escape  the  accident. 

5.  Medicines  play  an  important  role  in  the  causation  of  this  accident, 
such  as  active  cathartics,  laxatives  and  even  emetics.  The  administration 
of  quinine  has  been  followed  by  miscarriage,  although  oftentimes  it  has 
been  attributed  to  the  disease  and  not  to  the  medicine.  But  many  of  these 
drugs  cannot  be  blamed  for  the  accident,  as  there  usually  exists  a  tendency 
of  some  kind  to  a  miscarriage. 

6.  The  foetus  may  be  affected  by  the  same  diseases  as  the  mother, 
which,  if  it  should  cause  the  death  of  the  foetus,  will  produce  an  abortion. 
Excessive  distension  of  the  womb  due  to  plural  pregnancy  is  apt  to  pro- 
duce premature  contractions  of  the  womb,  with  a  resulting  miscarriage. 

Symptoms — -1.  There  may  be  premonitory  symptoms  such  as  flushing 
of  the  face,  alternate  flushes,  and  of  heat  and  chilliness,  pain  in  the  back, 
irritability  of  the  bladder  which  may  extend  to  the  rectum. 

The  characteristic  symptoms  are  hemorrhage  and  pains.  These 
pains  begin  in  the  lower  part  of  the  abdomen  and  on  both  sides  of  the 
same,  in  the  groin  or  just  above  it.  As  the  condition  progresses  these 
pains  extend  to  the  back,  and  later  on  pass  around  to  the  front.  The 
pains  begin  first,  to  be  soon  followed  by  a  bloody  discharge,  or  vice  versa. 
Some  cases  have  a  gush  of  watery  fluid  early  in  the  attack,  which  may  be 
slightly  discolored  with  blood;  this  discharge  does  not  necessarily  indicate 
rupture  of  the  ovus  and  hence  that  miscarriage  is  inevitable,  for  it  may 
occur  from  inflammatory  diseases  of  the  womb. 

2.  The  flow  of  blood  is  very  much  greater  than  that  which  occurs 


68f  DISEASES   TECULIAIl   TO    WOMEN. 

in  menstruation ;  large  clots  are  very  apt  to  be  passed,  in  which,  if  care- 
fully souglit  for,  the  ovum  may  be  found. 

3.  After  seven  or  eight  weeks  of  pregnancy  the  symptoms  of  abortion 
are  quite  plain.  Prior  to  that  time  it  may  be  mistaken  for  a  case  of  pain- 
ful menstruation. 

4.  If  the  pregnancy  has  advanced  beyond  three  months  the  foetus 
as  a  rule  escapes  first,  soon  to  be  followed  by  the  afterbirth.  If  the  after- 
birth is  not  expelled  the  woman  is  liable  to  suffer  from  hemorrhages  iiutil 
it  is  removed.  These  hemorrhages  may  be  so  great  as  to  cause  a  fatal 
result,  pro\ading  the  woman  has  not  a  physician  in  attendance. 

Treatment 1.  If  a  woman  is  subject  to  repeated  miscarriages  she 

should  exercise  every  care  to  place  herself  in  the  best  surroundings  during 
each  pregnancy.  At  the  regular  time  each  monthly  flow  is  expected  she 
should  remain  in  bed  for  a  few  days;  this  will  give  the  body  absolute  rest 
and  may  tide  her  over  to  full  time.  If  she  has  been  in  the  habit  of 
aborting  at  a  special  time,  say  the  third  or  fourth  month,  when  that  period 
is  reached  she  should  go  to  bed  several  days  before  the  time  expected  and 
remain  there  at  least  two  weeks. 

2.  If  the  abortions  are  due  to  syphilis,  a  course  of  mercury  and  iodide 
of  potash  should  be  instituted.  If  due  to  a  backward  displacement  of  the 
womb,  this  should  be  corrected  by  placing  the  womb  in  its  normal  position 
and  holding  it  there  with  a  pessary,  or  by  an  operation  if  necessary. 
Sexual  intercourse  during  preguaucy  should  bo  jjrohibited,  as  this  is  a 
very  frequent  cause  of  miscarriage. 

3.  ^^^len  a  pregnant  woman  feels  pains  in  the  lower  part  of  the 
abdomen,  soon  followed  by  the  discharge  of  blood,  or  sudden  discharge 
of  blood  followed  by  pain,  she  has  in  all  probability  a  threatened  mis- 
carriage. She  should  loosen  all  her  clothing  and  lie  down ;  her  drinks 
should  be  cold ;  twenty  drops  of  laudanum  with  half  a  teacupf ul  of  water 
should  be  injected  into  the  rectum,  or  a  half  grain  opium  suppository  may 
be  inserted.  If  the  symptoms  are  not  abated  in  one  hour  the  injection 
or  suppository  should  be  repeated,  and  again  at  the  end  of  the  second  and 
third  hours  if  needed.  If  the  patient  is  very  restless  and  nervous,  twenty 
to  thirty  grains  of  chloral  may  be  added  to  one  of  the  opium  injections; 
if  such  is  done  do  not  use  warm  water,  but  the  yolk  of  an  egg  and  some 
warm  milk,  in  order  to  prevent  the  drug  from  irritating  the  bowel. 

4.  The  opium  may  be  continued  from  day  to  day  as  long  as  there  is 
hope  of  arresting  the  abortion.  Meantime  once  in  two  days  the  bowels 
should  be  opened  by  a  warm  water  injection,   or  by  a  mild  laxative. 


CONCEPTION.  685 

Should  the  pain  and  hemorrhage  cease  it  is  better  for  the  patient  to  re- 
main in  bed  for  three  or  four  days  after  this  cessation ;  when  she  gets  up 
she  should  only  gradually  resume  her  usual  habits  of  life,  even  then  as 
an  experiment,  and  be  prepared  to  return  to  bed  at  the  first  recurrence 
of  the  former  symptoms. 

5.  Unfortunately  in  the  majority  of  cases  the  hemorrhages  do  not 
cease,  or  having  stopped  return,  and  the  abortion  is  apparently  inevitable, 
or  the  flow  may  be  so  great  that  it  will  be  necessary  to  complete  the 
abortion  in  order  to  save  the  life  of  the  woman. 

6.  If  the  abortion  is  inevitable  stop  the  bleeding  and  empty  the 
womb.  Hot  water  injections  may  be  valuable  to  accomplish  the  former. 
If  they  do  not  suffice,  then  the  vagina  should  be  tightly  packed  with 
antiseptic  gauze,  antiseptic  lamb's  wool,  or  pieces  of  boiled  linen  or 
muslin.  In  order  to  hold  the  packing  in  place,  a  najjkin  should  be  tightly 
applied. 

T.  When  an  inevitable  abortion  is  assured  the  physician  may  pack  the 
vagina  with  tampons  and  allows  them  to  remain  for  eighteen  or  twenty- 
four  hours,  and  usually  when  removed  the  ovum  (if  it  has  not  been 
previously  expelled)  and  the  afterbirth  will  be  found  forced  out  of  the 
womb.  If  the  afterbirth  does  not  come  away  in  twenty-four  hours  the 
woman  should  be  placed  under  an  anesthetic  and  the  womb  emptied  of 
its  contents.  If  not  the  discharge  in  a  few  days  will  have  a  very  bad 
odor,  and  the  patient  develop  blood  poisoning. 

Every  woman  who  has  a  miscarriage  shoiild  remain  in  bed  at  least 
ten  days  to  two  weeks  after  such  an  occurrence.  The  women  who  do  not 
properly  attend  to  this  accident  are  the  ones  who  later  in  after  life  pay  the 
penalty,  which  either  means  chronic  invalidism,  or  the  removal  of  one 
or  all  of  her  pelvic  organs,  which  may  or  may  not  result  in  death. 

CONCEPTION. 

Character A  woman  who  has  conceived  is  pregnant ;  pregnancy  be- 
gins with  conception  and  ends  with  labor,  jiroviding  an  abortion  does  not 
occur.  It  is  normal  when  the  uterine  cavity  contains  the  fecundated 
ovule  or  ovules;  and  abnormal,  ectopic  or  extra-uterine,  should  it  or 
they  be  outside  of  that  cavity. 

The  Ovule  or  Egg. — ^Each  month  when  menstruation  occurs  an  egg  or 
ovule,  as  it  is  called,  escapes  from  the  ovary.  An  ovule  may  come  from 
the  one  ovary  or  from  both,  or  two  or  more  may  come  from  tlie  sue, 


'686  DISEASES   PECULIAR  TO   WOMEN. 

and  so  forth.  Leading  from  the  ovai-j  into  tlic  cavity  of  the  womb  is  a 
tube  called  the  oviduct.  When  the  egg  or  ovule  drops  from  the  ovary, 
it  falls  into  the  end  of  this  tube,  which  by  a  wave-like  motion  conveys  it 
to  the  cavity  of  the  womb,  where  it  remains  until  the  next  menstrual 
period,  when  it  is  carried  off  with  the  flow.  A  new  one  is  then  deposited. 
It  is  estimated  that  women  during  their  menstrual  age  pass  many  thou- 
sands of  ovules. 

Twins — If  one  ovule  passes  down  and  the  woman  becomes  preg- 
nant that  month  the  result  will  be  one  baby;  if  there  are  two  ovules 
and  ini]ircgnation  occurs,  the  result  will  be  twins,  and  so  on. 

Ectopic  Pregnancy. — On  account  of  disease,  or  from  other  causes,  the 
progress  of  the  ovule  or  egg  may  become  obstructed,  then  the  egg  or 
eggs  will  become  lodged  in  the  tube.  Should  it  or  they  become  impreg- 
nated while  lodged  in  the  tube,  the  pregnancy  will  be  an  extra-uterine 
or  ectopic  pregnancy. 

How  Pregnancy  Occurs.- — How  does  impregnation  occur  ?  When  the 
male  has  intercourse  with  the  female  the  semen  of  the  male  is  deposited 
in  the  vagina  of  the  female  in  such  a  position  as  to  ''bathe"  the  neck 
of  the  Avomb.  The  heat  of  the  parts  causes  this  gelatinous  seminal 
discharge  to  liquefy.  The  semen  is  merely  a  solution  to  convey  the 
spermatozoids.  The  spermatozoid  is  composed  of  a  head,  of  a  tail  and 
of  an  intermediate  segment,  sometimes  called  the  body.  The  entire 
length  of  the  human  spermatozoid  is  not  more  than  1-500  to  1-325  of 
an  inch.  The  spermatozoids  have  an  eel-like  motion,  the  tail  being  the 
motile  power.  The  spermatozoids  move  along  until  one  of  them  comes 
in  contact  with  the  ovule,  the  head  then  enters  the  latter,  and  tlie  tail 
drops  off.  Conception  then  occurs.  Although  there  are  thousands  of  the 
spermatozoids  in  each  seminal  discharge,  it  only  requires  one  to  fecundate 
the  ovule. 

Movement  of  Spermatozoids. — Their  rate  of  movement  varies.  It  has 
been  estimated  about  three  inches  in  three  hours.  They  have  been  found 
alive  in  men  who  have  been  executed  seventy  and  even  seventy-two  hours 
after  death.  In  the  human  female  they  were  found  endowed  with  active 
movements  in  the  neck  of  the  womb  seven  or  eight  days  after  coition. 
In  temperate  climates  boys  of  twelve  years  may  have  discharges  simulat- 
ing the  seminal  fluid,  but  it  is  unusual  for  spermatozoids  to  be  found  in 
these  discharges  before  they  are  fifteen  or  sixteen  years  old.  One  care- 
ful investigator  claims  that  about  one-half  of  men  between  sixty  and  eighty 
years  of  age  are  capable  of  fecundation. 


STEEILITY.  687 


STERILITY. 


Causes.— 1.  When  a  woman  is  imablo  to  become  pregnant  she  is  said 
to  be  sterile  or  barren.  At  least  one  marriage  out  of  every  eight  is  child- 
less. It  is  commonly  believed  that  the  fault  is  always,  or  nearly  always, 
to  be  found  in  the  wife,  but  modern  investigation  has  shown  that  the 
husband  is  at  fault  in  about  one  case  out  of  every  six.  When  the  male 
is  at  fault  it  may  be  due  to  impotence,  which  is  an  inability  to  perform 
the  sexual  act  to  aspermatism,  although  he  may  succeed  in  getting  an 
erection  he  may  be  unable  to  have  an  ejaculation  of  semen;  or  to  zoo- 
spermia,  the  condition  in  which  the  ejaculated  semen  does  not  contain, 
spermatozoids,  and,  therefore,  has  no  fertilizing  power.  Or  again  the 
testicles  may  be  improperly  developed. 

2.  If  the  female  is  at  fault  it  may  be  due  to  the  absence  of  the  ova. 
In  chronic  inflammatory  diseases  of  the  ovaries  the  ovule  may  disap- 
pear, or  the  end  of  the  oviduct  may  become  closed.  If  such  be  the  case, 
the  egg  will  drop  into  the  general  peritoneal  cavity  and  be  absorbed. 
Another  cause  is  incapacity  for  sexual  intercourse,  such  as  absence  of 
the  female  organs  of  intercourse,  inflammatory  diseases  and  tumors  of  the 
vidva  and  vagina.  If  the  perineum  is  badly  torn  the  seminal  fluid  will 
flow  out,  a  cause  of  sterility. 

3.  A  frequent  cause  is  a  very  small  opening  in  the  neck  of  the 
womb,  which  is  not  sufiiciently  large  to  permit  the  spermatozoids  to  enter, 
and  is  termed  stenosis.     This  should  be  dilated  and  is  curable. 

Treatment — If  due  to  inflammatory  disease  resort  to  the  remedies 
described  for  the  various  inflammations  of  the  generative  organs. 

If  the  end  of  the  oviduct  is  occluded,  and  tumors  are  present,  or 
should  the  perineum  be  badly  torn,  or  a  small  opening  in  the  neck  of  the 
womb  be  the  cause,  then  an  appropriate  operation  will  be  the  only  pro- 
cedure which  will  tend  toward  future  conception. 

Lack  of  Orgasm. — A  condition  for  which  a  physician  is  frequently 
consulted  is  lack  of  the  normal  feeling  of  the  highest  sexual  excitement, 
called  orgasm.  With  such  the  fault  is  probably  due  to  some  imperfec- 
tion in  the  nervous  system.  The  lack  of  orgasm  may  be  found  in  other- 
wise healthy  women,  and  not  a  barrier  to  conception. 

In  those  who  have  never  experienced  the  orgasm  it  is  often  incurable. 
With  others  the  use  of  tonics,  or  pill  neuro-tonal  or  comp.  damiana  will  be 
found  effective. 


688  DISJSASKS    i-KCUI.IAK    TO    WOMEN. 


UTERINE  PREGNANCY. 


Nature's  Most  Wonderful  Miracle — It  has  been  well  said  lliat  every 
pregnant  woman  should  be  looked  upon  as  a  laboratory  in  which  nature 
is  performing  that  most  wonderful  of  all  her  miracles,  tiie  fashioning 
of  a  new  human  being,  and  that  nothing  should  be  allowed  in  any  way 
to  disturb  or  derange  this  most  important  operation.  Could  such  an  idea 
be  constantly  kept  in  mind  not  only  by  mothers  themselves,  but  by  all 
those  who  surround  or  even  momentarily  approach  the  female  M'ho  is 
performing  the  most  sublime  duty  of  her  sex,  that  of  continuing  the  race, 
and  every  effort  made  to  aid  her  in  accomplishing  this  great  function  in 
the  most  perfect  manner  possible,  what  vast  improvements  might  be  looked 
for,  even  in  the  next  generation  of  mankind. 

First  Indication  of  Pregnancy — The  first  indication  of  pregnancy  is 
generally  the  stoppage  of  the  monthly  periods,  and  it  is  also  one  of  the 
most  reliable  of  the  early  indications.  It  should  be  remembered,  how- 
ever, that  there  is  no  certain  sign  of  pregnancy,  none  which  has  not 
been  found  to  fail,  and  lead  into  errors  which  were  profoundly  mortify- 
ing, if  not  worse,  up  to  the  time  when  the  heart  of  the  infant  can  bo 
heard  to  beat  through  the  walls  of  the  mother's  abdomen.  This  beat  of 
the  child's  heart  can  seldom  be  positively  identified  before  the  fifth  month, 
and  often  not  until  the  sixth. 

Failure  of  Signs — In  some  instances  pregnancy  may  occur  and  yet 
the  monthly  flow  continue.  This  is  quite  common  for  one  or  two  months, 
and  less  frequent  for  four  or  five.  In  fact,  some  mothers  assert  that  the 
first  intimation  they  had  of  being  pregnant  was  quickening  or  feeling  the 
motion  of  the  child,  which  generally  makes  itself  evident  about  four  and 
a  half  months  from  the  date  of  conception. 

The  Morning  Sickness. — Morning  sickness  occurs  with  most  females 
for  the  first  few  months  of  pregnancy,  and  some  females  when  pregnant 
suffer  intensely  from  it.  It  usually  comes  on  whilst  dressing,  not  being 
felt  on  first  getting  up,  and  when  not  very  sevei'e  often  passes  off  later  in 
the  day  to  recur,  however,  the  next  morning.  It  differs  from  other  forms 
of  sickness,  such  as  those  which  are  due  to  disease  of  the  stomach  itself, 
in  that  as  soon  as  the  vomiting  is  over  the  patient  is  often  perfectly  well 
again,  and  can  take  food  immediately  afterward.  The  sensitiveness  of 
the  stomach  to  odors  and  flavors,  and  the  peculiar  ease  with  which  feel- 
ings of  nausea  are  brought  on  by  such  impressions  is  a  very  significant 


UTEEINE    rREGNANCY.  689 

sign,  and  rarely  fails,  if  supported  by  the  other  visual  symptoms,  to  indi- 
cate pregnancy  when  it  is  well  marked. 

Changes  in  Mammary  Gland. — Changes  which  occur  in  the  mammary 
glands  are  valuable  corroborative  signs.  They  consist  in  the  enlargement 
and  puifiness  of  tlie  nipple,  the  darkening  and  increase  of  size  of  the 
areola,  and  occasionally  the  secretion  of  milk.  These  indications  show 
themselves  during  the  second  and  third  months. 

ftuickening  Period. — Quickening  is  the  feeling  of  the  movements  of 
the  child,  which  is  so  constantly  noticed  by  the  mother  about  the  end  of 
four  and  a  half  months,  or  just  half  way  through  the  pregnancy,  that  it 
often  helps  to  fix  the  time  of  the  approaching  confinement.  The  first 
sensation  is  described  as  being  like  the  fluttering  of  a  bird,  or  the  creeping 
of  an  insect,  but  after  a  few  weeks  it  becomes  progressively  more  decided, 
and  more  perceptibly  like  the  struggles  of  an  infant  with  human  arms  and 
legs.  The  popular  idea  that  up  to  the  time  of  quickening  the  child  in  the 
womb  is  not  alive  is,  of  course,  totally  erroneous,  because  if  the  infant  was 
not  living  from  the  very  day  of  conception  it  would  not  grow  and  develop. 
It  is  only  felt  primarily  at  this  period  because  before  the  date  of  quicken- 
ing its  struggles  have  been  too  feeble  and  made  too  deeply  in  the  cavity 
of  the  abdomen  to  be  perceptible. 

Changes  in  Abdomen. — In  the  early  months  of  pregnancy  the  abdomen 
is  often  even  flatter  than  in  the  unimpregnated  female,  but  after  the  period 
of  quickening  enlargement  occurs,  and  in  the  latter  months  becomes  so 
great  as  to  cause,  in  many  instances,  a  good  deal  of  distress  by  mere  pres- 
sure, distension  and  weight.  The  stretching  of  the  skin  necessary  to  ren- 
der it  capable  of  covering  the  uterine  tumor  generally  gives  rise  to  nu- 
merous cracks  in  its  surface,  which  remain  as  whitish  scars  through  after 
life. 

Changes  in  Disposition. — Changes  in  temper  and  disposition,  longings 
for  strange  and  unsuitable  food,  drowsiness,  toothache,  heartburn,  palpita- 
tion of  the  heart,  and  so  forth,  are  less  constant  and  therefore  less  reliable 
symptoms  of  pregnancy,  some  of  which,  however,  occur  in  a  large  propor- 
tion of  the  cases. 

Duration  of  Pregnancy — This  average  date  is  i:sually  considered  for 
the  fruit  of  the  womb  two  hundred  and  eighty  days,  or  forty  weeks,  or  a 
week  over  nine  calendar  months,  from  the  day  of  the  cessation  of  the 
menstrual  discharge  when  last  seen  at  the  commencement  of  pregnancy. 
In  order  to  be  able  to  make  this  calculation  accurately  it  is  a  good  plan 
for  every  married  woman  to  keep  upon  a  calendar  a  regular  account  of  the 
U 


'69C  mSEAKES    rECULIAK   TO   WOMEN. 


OVARY  AND  MAMMARY  GLAND 

Figure  No.  i. — The  ovary,  showing  the  vesicular  bursted  and  the  large  grums 
which  tills  its  cavity. 

Figure  No.  2. — Change  in  the  breast  from  pregnancy. 

A.  Nipple. 

B.  Sebaceous  tubercles. 

C.  Spots  in  the  branded  areola. 

D.  Marks  due  to  the  enlargement  of  the  skin. 

Figure  No.  3. — Lobes  of  a  mammary  gland. 

A.  Acinos. 

B.  Canaliculi  or  small  canals. 

C.  Conduit   formed  by  several   small   canals. 

Figure   No.  4. — Mammary  gland. 

Figure   No.  5. — Mammary   gland   in   a   woman. 

a.  Nipple. 

b.  Areola. 

c.  c,  c,  c,  c.     The  gland  lobes. 

1.  Breast  or  enlarged  part  of  one  of  the  conduits  which  carry  milk. 

2.  Extremities  of  the  conduits  which  carry  milk. 


Figure  No.  1. 


Figure  No.  S. 


_  -,i mf:^^ 


f  "a> 


Figure  No.  2. 


Figure  No.  4  Figure  No.  5. 

OVARY  AND  MAMMARY  GLAND 

For  an  explanation  of  tlic  illustrations  sec  text  on  opposite  page. 

601 


692  DISEASES  rECTri,iAK  to  "womett. 

day  in  oaeh  month  -n-hen  she  ceases  to  be  unwell,  so  that  if  at  any  time 
before  the  next  period  impregnation  should  occur,  she  may  have  at  hand 
the  precise  datum  upon  which  to  base  her  preparations.  The  date  of 
quickening,  when  that  is  a  prominent  symptom,  as  is  the  case  in  most 
pregnancies,  ought  also  to  be  carefully  noted. 

Pre^ancy  Tahle.- — The  table  given  below  is  one  which  will  prove 
reasonablv  accurate: 


Jan 
Oct. 

I 
S 

-•    3 

9  10 

4     5 

II    1  2 

6    7 
13  14 

8 

I  ^ 

9  10  11 

16  17  18 

12    13  14  IS    16  17   18   19  20  21   22  23  24  25  2U  27  28  29  30  31 
10202122232425262728293031       1234567 

Nov. 

Feb. 

1 
8 

2    3 
9  lo 

4     5 

1113 

6    7 
13  14 

8 

IS 

91011 
16  17  l3 

12   13   14   15    16  17   18   19  20  21  22  23  24  25  20  2?  28 
192021222324252627282930      12345 

Dec. 

Marc 
Dec. 

I 
6 

2     3 

7     8 

4    5 
9  10 

6     7 

II   J2 

8 
13 

9  10  1 1 
II  IS  iS 

12   13   14  15   16  17  iS  19  20  21   22  23  24  25  20  27  28  29  30  3  I 
17  18  19  20  21   23  23  24  25  26  27  28  29  3031       12345 

Jan. 

April 
Jan. 

I 
6 

2     3 
7    8 

4    5 
9  10 

6    7 

11    12 

8 
13 

9  10  II 
1  I  IS  ifi 

12  13  14  15   16  17  18  19  20  21  22  23  24  25  20  2728  29  30 
17  18  19  20  21   22  23  24  25  26  27  28  29  30  31       1234 

Feb. 

May 
Feb. 

I 
S 

2     3 
6     7 

4     5 
8    9 

6    7 

10  II 

8 
12 

9  10  II 
13  U  IS 

12  13  14  IS   16  17  18   19  20  21  22  23  2425  26  27  2829  30  31 
16171819202123232425262728      1234567 

Jl/arrft 

March 

I 
8 

2    3 
9  lo 

4    5 

11   12 

678 

13  14  IS 

9  10  1 1 

16  17  18 

12  13  14  15   16  17  iS  19  20  21  22  23  24  25  26  27  28  29  30 
19202122232125262728203031       123456 

April' 

July 
April 

I 
7 

11 

4    5 

10  11 

6    7 
12  13 

8 

14 

9  10  11 

151617 

12  13  14  IS  16  17  18  19  20  21  22  23  24  25  26  27  2S  29  30  31 
1319202122232^252627282930      1234567 

ifav 

Aug. 
Mmi 

I 
8 

2    3 

9  lo 

4    5 

II    13 

6    7 
13  14 

8 

IS 

9  10  11 
16  17  iS 

12  13   14  15   16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31 
19  20  21   22  23  21  25  26  27  28  29  30  31       1234567 

June 

Sept. 

June 

1 
8 

2     3 

9  10 

4    S 

11    12 

6    7 
13  14 

8 
IS 

9  10  II 
16  17  18 

12  13   14  15   16  17   1 3  19  20  21  22  23  24  25  26  27  28  29  30 
192021222324252627282030      1234567 

July 

Oct. 
July 

I 
8 

2    3 
9  10 

4    5 

II    12 

6    7 

13  14 

8 

IS 

9  10  11 
iS  17  iS 

12  13   14  13   16  17  iS  19  20  21   22  23  24  25  26  27  28  29  30  31 
19202123232425262728293031       1234567 

AutT. 

Nov. 
Auf). 

I 
8 

2    3 
9  10 

4     5 

11    12 

678 
13  14  IS 

9  10  1 1 
l5  17  18 

1 2  1 3  1 4  1 5  1 6  1 7  1 8  1 9  20  2 1  22  23  24  25  26  27  28  29  30 

19  20  21   22  23  24  25  26  27  28  29  30  31       123456 

Sept. 

Dec. 

Sept. 

I 
7 

2    3 

8    9 

4    5 

10  II 

6    7 
12  l;! 

8 

14 

9  10  11 

IS  16  17 

12  13   14  15    16  17  18  19  20  21   22  23  24  25  26  27  28  29  30  31 
18  19  20  21   22  23  24  25  26  27  28  2930      1234567 

Oct. 

Explanation — Find  in  the  top  line  the  date  of  the  last  menstruation 
the  figure  below  will  indicate  the  date  when  the  confinement  may  be  ex- 
pected. If  the  date  of  menstruation  is  April  8,  then  the  date  of  expected 
confinement  will  be  January  13. 

Care  During  Pregnancy — The  pregnant  woman  should  a.?k  herself, 
before  making  even  a  trivial  variation  from  habits  of  life,  which  have  been 
proved  by  experience  conducive  to  her  individual  health,  "can  this  change 
produce  any  injurious  effect  upon  the  future,  mental  or  physical,  of  my 
darling  baby  ?"  and  imless  the  answer  is  unequivocally  in  the  negative,  it 
is  her  duty  to  refrain  from  incurring  unknown  risks  by  alteration  of  diet, 
exercise,  sleep,  clothing,  and  so  forth,  which,  previous  experience  has 
taught  her,  contribute  most  effectually  to  the  preservation  of  her  perfect 
sanitary  condition. 

Food  During  Pregnancy. — The  amount  of  food  taken  into  the  system 
during  the  early  period  of  pregnancy,  as  intimated  by  nature  in  the  broad 
hint  of  morning  sickness,  should  be  rather  less  and  of  a  more  easily 
digested  quality  than  at  ordinary  times.    But  in  the  latter  mouths,  when 


PEEGNANCT.  693' 

the  infant  is  rapidly  developing  and  material  must  "he  supplied  for  muscles 
and  bones  in  abundance,  the  quantity  of  aliment  should  be  largely  in- 
creased. It  is  better,  however,  to  eat  more  frequently  than  to  run  any 
risk  of  over-loading  the  stomach  at  such  time. 

Exercise — The  amoimt  of  exercise  should  also  he  ample,  since  this  13 
vitally  important  for  the  proper  assimilation  of  food  into  the  blood,  whence 
it  is  transferred  to  the  foetus  in  the  womb,  and  contributes,  of  course,  every 
litom  of  the  material  composing  the  little  body.  Care  must  be  taken,  how- 
ever, to  avoid  violent  exercise  of  any  kind  for  fear  of  bringing  on  abortion 
with  all  its  dangers  to  the  mother,  and  in  the  earlier  months  with  certain 
destriiction  to  the  child. 

Child  Blemishes. — As  regards  the  production  of  blemishes  and  defor- 
mities in  the  infant  by  mental  impressions  of  the  mother  during  preg- 
nancy, there  is  a  large  amount  of  evidence  that  such  an  effect  is  produced, 
although  many  of  the  stories  of  such  occurrences  are  grossly  exaggerated 
or  totally  without  foundation.  At  the  same  time  a  calm  and  equable  frame 
of  mind  is  greatly  to  he  desired  during  the  Avhole  period,  and  anything 
which  is  likely  to  operate  in  the  direction  of  causing  mental  shock,  de- 
pression or  excitement  should  be  scrupulously  avoided. 

Vomiting. — 1.  Among  the  diseases  of  pregnancy  are  excessive  vomit- 
ing, which  may  be  treated  Avith  tablespoonful  doses  of  lime-water,  iced 
carbonic  acid  water,  or  iced  champagne,  ginger,  bismuth,  hydrocyanic 
acid,  and  two-grain  doses  of  oxalate  of  cerium ;  heartburn,  from  which 
half  a  teaspoouful  of  bicarbonate  of  soda  or  ten  drops  of  aromatic  spirits 
of  ammonia  affords  relief. 

2.  If  the  nausea  is  due  to  a  prolapsed  or  bactward  displaced  womb, 
the  condition  will  be  relieved  by  rejilacing  the  womb  and  inserting  a 
lamb's  wool  tampon.  A  method  which  often  suffices  is  to  give  the  mother 
a  cup  of  hot  tea  and  a  cracker  about  an  hour  before  she  arises. 

The  following  prescriptions  are  advocated: 

Tincture  of  nux  vomica 3       drachms 

Hydrochloric  acid    '.i  ounce 

Essence    of   pepsin    3       ounces 

Teaspoonful  after  each  meal  and  at  bed-time. 

Bismuth  subnitratc   2  drachms 

Tincture  of  nux  vomica 10  drops 

OMake  into   ten  powders.     One   powder  every   hour. 

Carbolic  acid  or   creosote 10  drops 

Subnitrate  of  bismuth 2  drachms 

Ikl^kp  into  ten  powders.     One  every  two  hours, 


591  DISEASES   PECULIAR   TO    WOMEN. 

Excessive  Vomiting,  Treatment  of. — The  nausea  and  vomiting  may  be 
so  pronounced  as  to  be  uncontrollable  and  is  then  called  the  hyperemesis 
of  pregnancy.  "When  this  exists  nothing  will  remain  on  the  stomach,  and 
the  woman  rapidly  loses  flesh  and  becomes  very  much  exhausted.  When 
blood  appears  in  the  vomited  matter  of  these  cases  the  termination,  as  a 
rule,  is  unfavorable. 

The  treatment  consists  of  emptying  the  womb,  in  other  words,  pro- 
ducing an  abortion,  and  is  one  of  the  exceedingly  few  reasons  for  which  a 
physician  is  justified  in  producing  an  abortion. 

Constipation,  Treatment  of  the. — Constipation,  which  must  be  meddled 
with  very  cautiously  by  the  aid  of  mild  saline  laxatives,  such  as  a  teaspoon- 
ful  of  rochelle  salt,  a  dessertspoonful  of  castor  oil,  or  injections  of  soap 
and  water;  and  piles,  the  discomfort  of  which  can  be  palliated  only  by 
the  use  of  some  such  ointment  as  that  already  recommended,  or  daily 
doses  of  cascara. 

Toothache,  Treatment  of  the — If  toothache  comes  on  care  must  be 
taken  that  sound  teeth  are  not  extracted  in  the  vain  hope  of  relieving  it. 
When  teeth  decay  rapidly  in  pregnancy  it  seems  sometimes  to  be  due  to 
the  removal  of  the  bony  materials  for  the  purpose  of  building  up  the  skele- 
ton of  the  fcEtus,  and  efforts  should  be  made  by  supplying  the  lime  salts 
as  phosphates  or  bypoiihospliites  mixed  with  the  food  to  remedy  the  difB- 
culty.    Finely  powdered  bones  have  been  shrewdly  recommended. 

Enlarged  Veins,  Treatment  of  the — Enlargement  of  the  veins  of  the 
legs  sliould  be  treated  by  bandages  or  elastic  stockings,  and  dropsy  of  the 
feet  and  ankles  should  lead  to  an  immediate  examination  of  the  urine, 
lest  some  tendency  to  albuminuria  may  be  threatening. 

Bladder,  Treatment  of  the — Irritation  about  the  bladder,  perbaps  witb 
incontinence  and  retention,  occasion  much  inconvenience,  but  can  often  be 
relieved  by  gentle  laxatives  and  diuretics,  siich  as  the  cream  of  tartar,  or, 
if  very  troublesome,  by  a  belladonna  and  opium  suppository.  The  patient 
should,  however,  be  guarded  against  the  possibility  of  becoming  fond  of 
the  action  of  anodynes,  especially  opium  or  chloral,  at  this  trying  .time. 

LABOR. 

Definition. — Labor  is  the  end  of  pregnancy,  and  may  be  defined  as 
the  process  by  which  the  foetus  and  the  afterbirth  are  separated  from  the 
mother.  T^ature's  design  being  the  continuance  of  the  race,  the  foetus 
must  have  reached  such  development  before  its  expukion  that  it  is  viable ; 


LABOE.  695 

that  is,  capable  of  living  external  to  the  mother.  If,  therefore,  the  product 
of  conception  be  expelled  before  such  capability,  the  process  is  not  called 
labor,  but  abortion  or  miscarriage. 

Premature  Labor — Should  labor  occur  in  the  seventh  or  eighth  month 
it  is  called  premature,  because  the  foetus  has  not  attained  its  perfect  de- 
velopment ;  if  labor  be  delayed  beyond  nine  months  it  is  called  postponed, 
if  the  foetus  be  alive,  but  missed  if  it  be  dead. 

Parturition. — Parturition  is  a  term  very  often  used  instead  of  labor. 
When  parturition  occurs,  with  the  efforts  of  the  womb  and  the  woman 
alone,  it  is  called  natural ;  but  if  it  is  necessary  to  render  aid,  usually  by 
the  apiilication  of  forceps,  it  is  called  au  artificial  or  instrumental  labor. 
In  order  that  a  labor  may  be  natural  the  foetus  must  not  exceed  the  normal 
size  and  the  presentation  must  be  normal,  also  the  passageway  and  the 
muscular  forces  required  to  cause  the  expulsion  of  the  passenger. 

Duration  of  Labor — This  varies  with  race,  place,  climate,  manner  of 
living,  hereditary,  physical  conformation,  whether  first  or  subsequent 
labor,  and  with  the  sex,  presentation  and  position  of  the  child.  Labor  is 
shorter  in  warm  than  in  cold  climates,  in  savage  than  in  civilized  races,  in 
women  in  the  country  accustomed  to  plain  food,  outdoor  exercises  and 
regular  habits,  than  in  those  leading  opposite  lives  in  the  city.  In  the 
primipara  (a  woman  who  is  having  her  first  baby)  it  is  longer  than  in 
the  multipara  (a  woman  who  has  had  more  than  one  child)  ;  it  is  also 
longer  when  the  face  or  buttocks  come  first  instead  of  the  head,  and  with 
male  than  female  children. 

Labor  with  First  Child — ^^As  a  rule  the  primipara  is  in  labor  fifteen  to 
twenty  hours;  the  multipara  six  to  eight  hours.  If  the  primipara  is 
thirty-five  years  old  and  more,  labor  may  be  prolonged  for  twenty-one  to 
twenty-seven  hours;  above  forty-one  years  labor  is  very  apt  to  be  thirty- 
three  hours. 

Duration  of  Second  Stage. — The  second  stage  of  labor  is  generally  one- 
third  that  of  the  first  stage.  The  majority  of  labors  begin  between  9  and 
12  P.  M.,  and  end  between  9  P.  M.  and  9  A.  M. 

Birth  Presentation. — The  presentation  of  the  child  varies.  By  far  the 
greater  majority  of  the  children  are  born  head  first.  The  child  may 
present  by  the  head,  buttocks  (when  it  is  called  a  breech) ,  face  and  either 
ehoulder.  The  vertex  or  head  may  demand  forceps  application  at  times, 
especially  if  at  the  expiration  of  any  hour  during  the  second  stage  it  fails 
to  progress.  Should  the  face  present,  the  physician  will  endeavor  to 
push  it  up  and  change  it  to  a  vertex,  otherwise  it  will  be  necessary  to  apply 


696  DISEASES   PECULIAR    TO    WOMEN. 

forceps.  Such  a  child  will  have  a  blackened  face,  which  diseoloi-ation  at 
the  end  of  a  week  or  ten  days  will  disappear. 

Buttock  Presentation. — If  the  buttocks  present,  more  or  less  difficulty 
will  occur,  and  it  may  be  necessary  to  apply  force  to  the  after-coming  head. 

Shoulder  Presentation — A  shoulder  presentation  will  require  an 
entire  change  of  the  position  of  the  child,  as  this  is  an  imiDossible  labor. 
As  a  rule  both  feet  are  brought  down  first,  the  head  being  born  last. 

Preparations  for  Labor. — The  lying-in  chamber  should  be  large  enough 
for  suitable  ventilation,  and  yet  not  so  large  as  to  be  with  difficulty 
heated.  Every  precaution  to  secure  for  the  invalid  a  full  supply  of  un- 
polluted air  should  be  instituted,  and  conveniences  for  affording  hot  water 
at  short  notice  are  of  importance.  The  bed  should  be  a  hair  or  spring 
mattress,  which  ought  to  be  covered  with  some  waterproof  material ; 
over  this  a  thick,  old  spread,  newspapers  or  comfortable,  to  absorb  the 
blood  and  other  discharges,  should  be  laid,  and  this  again  covered  with 
a  sheet.  The  remaining  bed-covering  must  be  arranged  according  to  the 
season  of  the  year.  In  this  room  should  be  collected  all  the  clothing  which 
will  be  needed  for  the  comfort  of  the  mother  and  expected  infant,  and 
besides  the  articles  of  every-day  use  there  should  be  provided  a  strong 
sheet,  which  can  be  tied  around  the  post  at  the  foot  of  the  bed,  for  the 
patient  to  pull  upon  during  her  pains,  a  firm  cushion  for  her  to  press  her 
feet  against  if  she  so  desires,  an  abundant  supply  of  towels,  plenty  of  soap 
and  warm  water,  a  pound  or  so  of  lard  free  from  salt,  a  few  yards  of 
flannel,  a  soft,  warm  shawl  or  small  blanket  to  receive  the  baby  in  before 
it  is  washed,  sharp-edged  but  blunt-pointed  scissors  to  cut  the  cord  or 
navel  string,  eight  yards  of  coarse  sewing  cotton  doubled  eight  times  and 
knotted  at  the  two  ends  for  tying  the  cord,  a  binder  of  strong  new  muslin 
about  a  yard  and  a  half  in  length  and  half  a  yard  wide,  or  larger  if 
needful,  and  a  paper  of  large,  strong  safety  pins  for  fastening  the  same 
around  the  invalid's  abdomen  after  she  is  delivered. 

The  Mother's  Dress — The  dress  of  the  patient  should  be  the  usual 
chemise  and  night-dress  rolled  up  around  her  waist,  so  as  to  keep  them 
from  being  soiled,  and  a  sheet  folded  in  four  and  pinned  around  her 
limbs  as  a  skirt,  fastening  it  at  the  right  side  so  that  it  can  easily  be  un- 
pinned and  slipped  down  out  of  the  way  when  the  labor  is  completed. 

Stages  of  Labor. — Labor,  jiarturition  or  confinement,  is  divided  into 
three  stages.  The  first  consists  in  the  dilation  of  the  mouth  of  the  womb, 
sufficiently  large  to  permit  the  foetus  to  escape.     The  second  constitutes 


I^AliUll, 


697 


tlic  biitli  of  the  cliilJ.  Tlio  third  is  the  expulsion  of  the  placenta  or  after- 
liirth. 

Pirst  Stage  of  Labor — During  the  first  stage  of  labor  the  patient  may 
wall:  around  the  room,  sit  up  iu  a  chair  or  lie  upon  a  lounge,  as  is  most 
agreeable  to  her,  but  when  the  mouth  of  the  uterus  is  dilated  to  the  size  of 
a  silver  half-dollar  she  should  take  her  jjosition  upon  her  left  side,  with 
her  hips  near  the  edge  of  the  bed,  and  about  a  foot  lower  down  than  she  is 
accustomed  to  lying.  In  this  jiosturc  the  medical  attendant  can  best  aid 
her  in  her  trial  until  toward  the  end  of  the  process,  when  some  advantage 
is  often  gained  by  placing  the  patient  upon  her  back. 

Preparing  the  Nipples — Preparation  of  the  nipples  should  be  made 
by  washing  them  with  strong  green  tea,  or  solution  of  a  drachm  of  tannin 
in  two  ounces  of  cologne  water,  twice  daily  for  thi-ee  weeks  before  con- 
finement, in  order  to  harden  the  skin  and  render  it  less  liable  to  crack  and 
become  sore  whilst  nursing. 

Period  of  Actual  Labor — The  period  of  actual  labor  is  generally 
ushered  iu  with  slight  griping  pains  in  the  abdomen,  and  more  or  less 
aching  in  the  back,  which  come  on  at  first,  joerhaps,  at  intervals  of  half 
an  hour,  lasting  for  a  minute  at  a  time ;  then  at  intervals  of  ten  or  fifteen 
minutes,  and  so  on  until  they  grow  severe  and  the  sjoace  of  respite  between 
them  dwindles  to  five,  four  or  even  three  minutes. 

Pains  and  Length  of  First  Stage — In  the  first  stage  of  labor  the  pains 
have  a  cutting  or  tearing  character,  and  are  commonly  felt  in  the  stomach, 
or  lower  part  of  the  abdomen,  and  also  in  the  back.  They  are  accompanied 
by  a  frequent  desire  to  pass  water,  produced  by  the  pressure  of  the  child's 
head  upon  the  urinary  bladder  as  it  descends,  and  often  by  a  disposition 
to  evacuate  the  bowels,  from  a  similar  cause.  Pressure  of  the  head  like- 
wise frequently  produces  severe  cramps  iu  the  legs,  which  may  be  partly 
relieved  by  friction,  but  often  disappears  as  the  labor  progresses.  The 
duration  of  this  stage  varies  greatly,  but  in  a  labor  of  twelve  hours'  dura- 
tion, the  usual  proportion  would  probably  be  ten  hours  in  the  first  stage, 
an  hour  and  three-quarters  in  the  second  stage,  and  fifteen  minutes  in 
the  third. 

Pains  of  Second  Labor In  the  second  stage  of  labor  the  character  of 

the  pains  and  the  expulsive  efforts  which  accompany  them  is  changed. 
They  now  become  what  are  commonly  called  bearing-down  pains,  in  which 
the  patient  almost  instinctively  endeavors  to  aid  the  contractions  of  the 
uterus  in  its  efforts  to  empty  itself,  by  straining  as  if  at  stool ;  and,  indeed, 
should  she  seem  reluctant  to  yield  to  this  disposition,  she  ought  to  be  in- 


698  DISEASES   PECULIAR   TO    WOMEN. 

structed  to  bear  down  exactly  as  if  her  bowels  were  being  moved  whilst 
constipated.  The  cries  emitted  are  generally  more  like  prolonged  grunts, 
and  can  be  readily  recognized  at  a  considerable  distance  by  one  who  is 
familiar  with  their  peculiarities.  After  a  continuance  of  these  pains  for 
one,  two  or  more  hours  the  child's  head,  if  that  comes  first,  as  happens  in 
probably  nineteen  out  of  every  twenty  cases,  begins  to  press  upon  the 
external  parts  or  vulva,  and  finally,  with  an  unusually  forcible  pain,  often 
with  a  piercing  cry  from  the  mother,  her  baby's  head  emerges  into  the 
world.  As  a  rule,  the  next  pain  expels  the  shoulders  and  hips,  the  rest 
of  the  body  offering  little  resistance  to  the  expulsive  efforts  of  the  womb 
after  the  head  is  born. 

Third  Stage  of  Labor. — The  third  stage,  consisting  In  the  delivery  of 
the  placenta,  is  usually  attended  with  one  or  two  slight  pains,  by  which 
the  afterbirth  is  forced  out  of  the  womb  into  the  vagina,  whence  it  must 
usually  be  removed  by  the  medical  attendant. 

Although  in  the  majority  of  caseswany  intelligent  person  could  suc- 
cessfully manage  a  case  of  labor,  there  are  numerous  accidents,  malposi- 
tions and  complications,  which  may  occur  without  any  warning  in  any 
particular  case,  so  that  if  skilled  medical  assistance  can  possibly  be  pro- 
cured it  should  by  all  means  be  sent  for.  The  man  or  woman  who  neg- 
lects this  rims  a  terrible  risk  of  being  the  murderer  of  the  mother  or  6f 
the  child,  perhaps  of  both. 

Duty  of  Midwife — But  if  no  qualified  physician  is  procurable,  the 
acting  midwife  should  from  time  to  time,  say  every  ten  minutes  dur- 
ing the  second  stage  of  labor,  anoint  the  vulva  or  external  parts  of  gen- 
eration of  the  patient  freely  with  lard,  at  the  same  time  examining  very 
gently,  with  the  finger,  what  progress  is  being'  made  In  the  descent  of  the 
head,  supposing,  as  is  usually  the  case,  that  forms  the  presenting  part,  as 
this  too  frequently  causes  puerperal  sepsis,  which  see. 

The  Delivery. — The  moment  the  head  Is  born  the  finger  should  be 
repassed  in  around  the  Infant's  neck,  so  as  to  find  out  whether  the  navel- 
string  is  wound  around  it,  as  not  unfrequently  happens.  If  such  Is  tbo 
case,  the  cord  should  be  pulled  down  a  little,  and  the  mother  urged  to 
bear  down  for  the  child's  sake,  as  rapidly  as  possible,  and  complete  the 
birth ;  when  the  cord  must  be  Immediately  loosened  and  slipped  over 
the  baby's  head  to  save  it  from  strangulation.  At  the  same  moment  the 
head  of  the  child  comes  into  the  world  the  midwife's  other  hand  should 
be  placed  upon  the  lower  portion  of  the  mother's  abdomen,  and  the  uterus 
pressed  upon  gently. 


LABOE.  699 

Treating  the  Womb. — As  the  body  of  the  child  is  born  the  uterus 
should  contract  to  the  size  of  a  ball,  apparently  about  five  inches  in 
diameter,  and  if  this  does  not  take  place,  the  womb  should  be  firmly 
grasped  through  the  walls  of  the  abdomen,  in  the  hand,  and  so  stimulated 
to  due  contraction.  This  is  very  important,  because,  if  it  does  not  occur 
promptly  the  patient  may  bleed  to  death  in  a  very  few  minutes. 

Attending  the  Child — As  soon  as  the  womb  is  found  to  be  properly 
contracted  into  this  hard  ball,  attention  should  be  turned  to  the  child. 
If  it  cries  at  once,  the  cord  may  be  immediately  tied  an  inch  and  a  half 
from  its  attachment  to  the  infant,  with  the  sewing-cotton  already  pro- 
vided, and  then  cut  half  an  inch  above  this  again,  that  is,  half  an  inch 
further  away  from  the  child,  squarely  off.  The  baby  is  then  to  be  lifted 
up,  with  both  hands  clasped  around  its  body,  for  it  is  very  slippery,  and 
received  by  an  attendant  in  the  flannel  or  old  blanket,  which  has  also  been 
prepared.  The  attendant  ought  either  to  hold  it  until  the  labor  is  com- 
pleted, or  to  place  it  on  its  left  side,  in  some  safe  situation,  preferably  in 
its  cradle  or  crib,  not  in  an  armchair,  where  it  may  be  crushed  to  death 
by  being  sat  upon. 

Expelling  the  Afterbirth. — ^During  this  time  the  midwife  should 
keep  her  hand  upon  the  patient's  abdomen,  gently  pressing  and  knead- 
ing the  womb  occasionally,  in  order  to  promote  the  recurrence  of  a  con- 
traction, strong  enough  to  expel  the  placenta.  As  long  as  the  afterbirth 
remains  the  woman  is  not  safe  from  dangerous  or  fatal  flooding;  but 
whilst  the  uterus  continues  firmly  contracted,  and  feels  like  a  hard  ball 
under  the  fingers  of  the  midwife,  there  is  but  little  danger.  After  five 
or  ten  minutes,  if  slight  pains  come  on,  the  mother  should  bear  down  a 
little,  and  the  cord  be  gently  pulled  upon,  when,  in  many  instances,  the 
placenta  comes  away.  As  it  reaches  the  vulva,  the  patient  should  be 
told  to  cease  her  efforts,  and  the  midwife  should  twist  the  afterbirth  round 
and  round  on  itself,  eighteen  or  twenty  times,  gradually  withdrawing  it 
at  the  same  moment.  This  is  to  wind  the  membranes,  or  bag  which  held 
the  water  into  a  string,  if  possible,  inside  the  vagina,  and  perhaps  the 
uterus,  so  that  they  may  all  come  away  with  the  placenta  in  safety.  The 
mass,  when  removed,  should  be  laid  away  for  subsequent  careful  examina' 
tion,  in  order  to  determine  whether  any  part  has  been  left  in  the  mother, 
as  the  effects  of  such  an  accident  are  much  to  be  dreaded. 

Contracting  the  Womb. — The  attention  of  the  midwife  should,  how- 
ever, immediately  return  to  the  mother,  and  her  hand  at  once  applied 
again  over  the  abdomen,  when  the  womb  ought  to  be  felt  as  a  ball  of  somQ 


"TOO  DISEASES   PECDI.TAR   TO   WOMEN. 

three  and  a  Lalf  inches  in  diameter,  or  about  the  size  of  the  new-horn 
baby's  Lead,  and  even  harder  lliau  before.  If  not  so  felt,  firm  pressure 
and  friction  over  the  abdomen  must  be  made  to  induce  it  to  contract. 
Should  it  not  do  so  within  a  minute  or  two  the  midwife  must  iutroduco 
her  hand  up  the  vagina  into  the  cavity  of  the  womb,  under  strictly  anti- 
septic precautions,  and  pulling  out  the  clots  of  blood  she  will  probably 
find  there,  strive  again  to  excite  the  womb  to  its  proper  contraction. 

To  Prevent  Flooding.. — Should  these  efforts  prove  unavailing,  not  a 
moment  is  to  be  lost,  for  the  next  five  minutes  will  perhaps  cost  the 
patient  her  life  by  flooding.  Let,  therefore,  a  piece  of  ice,  a  sponge 
dipped  in  vinegar,  or  a  peeled  and  gashed  lemon,  be  carried  up  with  one 
hand  and  rubbed  around  inside  of  the  womb,  whilst  the  other  hand  of  the 
midwife,  by  firm  pressure  and  friction  over  the  patient's  abdomen,  con- 
tributes to  stimulate  that  uterine  contraction  in  which  lies  the  mother's 
only  safety.  Or  a  teaspoonful  of  ergot,  repeated  in  fifteen  to  twenty 
minutes.  As  soon  as  this  is  accomplished,  as  it  probably  will  be  by  these 
remedies,  a  tight  bandage  should  be  pinned  around  the  patient's  body, 
with  two  or  three  folded  napkins  beneath  it,  pressing  upon  the  part  of  the 
abdomen  over  the  womb,  to  prevent  relaxation,  which  hajipily  seldom  oc- 
curs when  thus  treated. 

Making  the  Mother  Comfortable ^After  being  securely  bandaged,  the 

patient  may  be  lifted  up  a  little,  out  of  the  wettest  part  of  the  bed,  if  it 
can  be  done  without  any  effort  on  her  part;  but  for  fear  of  flooding,  the 
more  quiet  the  parturient  is  kept  for  the  first  two  hours  after  labor,  or 
until  ihe  blood  has  had  time  to  clot  firmly  in  the  large,  open-mouthed  veins 
of  the  uterine  cavity,  the  less  is  her  danger.  When  the  patient  is  made  as 
comfortable  as  possible,  a  clean  napkin,  loosely  folded,  is  to  be  placed  be- 
tween the  thighs,  but  not  pressed  up  tightly  against  the  vulva,  lest  it  act  as 
a  plug  and  prevent  the  detection  of  flooding,  should  that  come  on. 

Shonld  the  Child  Not  Cry — In  case  the  child  docs  not  cry  when  first 
born,  its  mouth  should  be  carefully  cleared  of  mucus  and  other  obstruc- 
tion, and  a  little  cold  water  sprinkled  upon  its  breast.  Should  this  fail  in 
rousing  a  gasping'  effort  at  breathing,  the  baby,  still  attached  to  the  cord, 
if  that  is  pulsating,  should  be  put  into  a  basin  of  very  warm  water,  and 
after  a  minute  or  two,  when  the  surface  of  its  body  is  well  heated,  the 
dash  of  cold  water  over  its  face  and  breast  again  tried.  If  still  unsuccess- 
ful, the  baby  should  be  wrapped  up  in  hot  flannels,  and  artificial  respira- 
tion, by  blowing  into  the  moiith  whilst  the  nostrils  are  held,  and  then 
forcing  the  air  out  by  compressing  the  chest,  attempted  as  a  forlorn  hope. 


The  writer  has  found  the  results  of  dry  heat,  applied  by  cautious  roast- 
ing before  a  fire,  promising  enough  to  warrant  further  employment  in 
otherwise  hopeless  cases. 

Baby's  First  Bath — If,  on  the  contrary,  the  child  cries  lustily,  and 
the  mother  is  doing  as  well  as  can  be  expected,  the  cord  should  be  again 
examined  to  verify  the  fact  of  its  being  securely  ligated,  and  the  baby 
given  its  first  bath.  The  infant  shoidd  be  rubbed  all  over  with  lard,  to 
soften  the  vernix  caseosa  or  cheesy  matter  with  which  it  is  more  or  less 
covered,  then  well  washed  with  white  castile  soap  and  milk-warm  water 
and  thoroughly  dried. 

Dressing  the  Navel. — The  cord  is  dressed  by  being  drawn  through  a. 
hole  cut  in  the  middle  of  a  ijiece  of  soft  old  linen,  folded  once,  and 
trimmed  to  four  inches  square,  and  after  being  wrapped  in  this  is  laid 
upward  on  the  baby's  stomach,  and  bound  in  place  by  a  belly-band  o£ 
silver  flannel,  fitted  snugly  but  not  too  tight,  and  secured  by  safety  pins 
or  a  few  stitches,  or  the  cord  can  be  dressed  in  absorbent  cotton  and  freely 
covered  with  boric  acid. 

Of  the  Throng  Presentations — The  management  of  labor  when  the 
back  of  the  head  does  not  come  downi  first,  and  especially  when  the  but- 
tocks, feet,  or  arms  present,  is  so  apt  to  be  difficult  and  dangerous  that  a 
physician  ought  always  to  be  simimoued,  even  from  a  great  distance  and  at 
the  utmost  inconvenience,  shoidd  any  signs  of  a  "cross-birth,"  as  it  is  popu- 
larly called,  be  detected,  or  should  unusual  delay  in  delivery  render  ob- 
struction probable.  It  will  sometimes  bo  a  comfort  to  a  woman  in  labor 
who  is  anxiously  awaiting  the  physician's  arrival  to  be  reminded  that  if 
the  birth  comes  before  the  doctor  it  will  be  because  everything  is  all  right, 
whilst,  on  the  contrary,  if  there  be  anything  wrong,  the  physician  will 
usually  have  ample  time  to  reach  her  before  his  services  are  actually 
needed. 

After-Management  of  labor. — The  management  after  labor  should  be 
such  as  will  best  avoid  any  excitement,  either  mental  or  physical,  liable 
to  light  up  inflammatory  action  in  the  womb,  which  has  just  been  the  sub- 
ject to  such  momentous  change.  The  patient,  in  ordinary  cases,  ought  to 
remain  in  bed  until  the  twelfth  or  the  fourteenth  day,  partaking  of  semi- 
solid food  until  the  third  day,  when  the  bowels  should  be  moved.  For 
this  purpose  she  may  bo  given  a  bottle  of  the  citrate  of  magnesia  in  two 
doses,  one-half  hour  apart,  salts  or  an  enema.  After  the  bowels  have  been 
thoroughly  moved,  solid  food  shoidd  be  given.  She  should  not  receive 
company  for  at  least  three  days,  but  devote  all  her  energies  to  the  task 


f02  DISEASES    TECULIAU    TO    WOMEN. 

of  recovering  as  speedily  as  possible,  both  on  her  own  account  and  for  the 
cake  of  the  frail,  new  life  so  utterly  dependent  upon  her  care. 

PUERPERAL  CONDITIONS. 

Character. — The  puerpcrium,  or  the  puerperal  stage,  is  the  two  weeks 
following  the  birth  of  the  child.  It  begins  immediately  upon  the  expul- 
sion of  the  placenta. 

Among  the  conditions  of  the  puerperal  state  may  be  mentioned  after- 
pains,  which,  though  seldom  troublesome  subsequent  to  first  deliveries, 
may  in  others  cause  more  suffering  than  the  labor  itself. 

After-Pains They  can,  however,  be  greatly  relieved  by  the  iise  of 

ergot  just  as  delivery  is  accomplished,  and  of  one-half  grain  opium  sup- 
positories, or  forty-drop  laudanum  injections,  or  a  Dover's  powder,  in 
two  or  throe  hours  if  they  persist. 

Sore  Nipples. — Soreness  of  the  nipples  and  cracked  nipples  are  very 
apt  to  come  on  in  patients  with  tender  skins  from  the  constant  irritation 
of  the  baby's  gums  in  nursing,  and  are  unfortunately  very  difficult  to 
heal,  because  the  same  irritation  which  originated  the  trouble  in  the 
first  place  is  continually  kept  up. 

Treatment  of  Nipples. — Vaseline,  zinc  ointment,  laudanum  and  ni- 
trate of  silver  sometimes  succeed  in  curing  the  sore,  but  the  most  success- 
ful plan  is  to  use  a  wooden  shield  with  a  rubber  nipple  if  the  baby  can  be 
persuaded  to  consent  to  the  innovation.  Women  who  suffer  in  succeed- 
ing pregnancies  from  this  condition  may  do  much  to  prevent  its  recur- 
rence. About  three  months  prior  to  the  expected  date  of  confinement,  rub 
the  nipples  night  and  morning  with  cocoa  butter  and  expose  them  several 
hours  daily  in  the  sunlight.  Before  and  after  nursing  the  nipples  of  the 
mother  and  the  mouth  of  the  baby  should  be  washed  with  a  solution  of 
a  teaspoonful  of  boric  or  boracic  acid  in  a  tumblerful  of  water.  The 
nipples  should  be  thoroughly  dried. 

Danger  of  Cracked  Nipples — The  great  danger  of  cracked  nipples 
is  that  it  may  lead  to  abscess  of  the  mammary  glands  (the  so-called 
gathered  breasts). 

CHILD-BED  FEVER  OR  PUERPERAL  FEVER. 

Character — Puerperal  fever  is  a  very  dangerous  disease,  which  I3 
invariably  due  to  a  lack  of  antiseptics.  All  cloth  or  napkins  that  come 
in  contact  with  the  vulva  of  the  woman  which  have  not  been  boiled,  the 


CHILD-BED  FEVEB.  103 

hands  of  those  attending  to  her  unless  thoroughly  washed,  all  instruments 
used  unless  rendered  aseptic  will  carry  dirt  of  some  kind,  giving  rise  to 
this  condition,  which,  practically  speaking,  is  blood  poisoning. 

It  generally  comes  on  or  about  the  third  to  the  fourth  day  after 
delivery  with  a  violent  chill,  great  thirst  and  extreme  prostration. 

Symptoms — The  uterine  discharge,  or  lochia,  which  should  persist 
for  ten  days  to  two  weeks,  becomes  very  foul,  the  odor  of  which  is 
nauseating,  or  it  quickly  dries  up. 

The  fever  may  run  very  high,  and  diarrhoea  with  obstinate  vomiting 
may  set  in.  The  mind  soon  grows  clouded,  if  the  attack  be  a  severe  one, 
muttering  delirium  makes  its  appearance,  and  the  patient  often  dies  on 
the  third  to  the  seventh  day  of  the  attack  in  a  condition  similar  to  that 
observed  in  typhus  fever. 

Treatment. — A  large  majority  of  the  cases  prove  fatal,  but  full  doses 
of  twenty  to  thirty  grains  of  quinine,  with  one-thirtieth  grain  of  strych- 
nine sulphate  every  two  to  three  hours,  succeeds  in  saving  a  small  propor- 
tion of  the  cases.  If  an  abscess  forms,  be  it  in  the  pelvis  or  elsewhere, 
it  shoiild  be  incised  and  drained.  Cold  sponge  baths  every  two  or  three 
hours  will  reduce  the  fever,  and  an  ice  bag  to  the  head  will  oftentimes 
prevent  brain  complications.  Injections  of  bichloride  of  mercury  should 
be  used  once  or  twice  a  day. 

Puerperal  Mania — This  is  a  form  of  insanity  liable  to  come  on  a 
week  or  ten  days  after  confinement,  in  which  there  is  frequently  a  singu- 
lar aversion  to  the  child,  and  perhaps  to  the  husband  also.  A  tendency 
to  suicide  is  also  prominent,  and  patients  thus  affected  should  be  watched 
with  the  most  unremitting  care.  Under  perfect  rest,  nourishing  diet, 
moderate  stimulation  and  sedatives  persons  generally  recover. 

Puerperal  Convulsions — These  may  come  on  before  or  during  labor, 
as  well  as  in  the  montli  following  delivery.  They  are  generally  due  to 
accumulation  of  urea  in  the  blood,  the  consequence  of  temporary  Bright's 
disease,  resulting  probably  from  the  pressure  of  the  uterus  containing 
the  foetus  upon  the  kidneys.  The  treatment  has  already  been  pointed  out 
under  the  head  of  uremia. 

Milk-Leg — This  is  an  inflammation  of  the  lymphatics  of  the  limb, 
coming  on  especially  toward  the  end  of  the  second  week  after  labor  and 
deriving  its  name  from  the  milk-white  appearance  usually  presented  by 
the  skin  of  the  affected  part.  As  the  febrile  state  of  the  system  is  apt  to 
cause  drying  up  of  the  milk,  it  was  formerly  supposed  that  in  some 
mysterious  way  the  lacteal  fluid  was  transferred  to  the  leg.     At  first  it 


104  DISEASES   PECnLIAR   TO    WOMEN. 

may  be  quite  painful,  but  after  the  integument  becomes  accustomed  to 
distension,  the  sensations  are  rather  those  of  weight  and  discomfort  than 
of  positive  suiferiug.  The  treatment  is  by  hxudauuni  or  turpentine  fo- 
mentation at  first,  and  later  with  stimulating  and  anodyne  liniments, 
Avhich  hasten  a  little  the  naturally  tardy  convalescence.  The  ordinary 
duration  of  the  affection  is  from  a  month  to  six  weeks. 

MANAGEMENT  OF  THE  INFANT. 

Suckling  the  Baby. — After  a  baby  has  received  its  first  bath,  and 
been  for  the  first  time  introduced  to  the  mysteries  and  miseries  of  clothes, 
it  should  be  put  to  the  breast  for  the  purpose  of  extracting  whatever 
nourishment  nature  has  there  provided  for  it,  and  also  as  the  commence- 
ment of  its  education  in  the  art  of  nursing,  a  business  upon  which  its 
life  for  some  months  will  depend.  Curiously  enough  whilst  some  chil- 
dren take  hold  of  the  breast  as  if  by  instinct,  others  must  be  taught  to 
nurse,  and  show  for  this  vital  operation  all  the  perverse  imwillingness 
of  Shakespeare's  schoolboy,  notwithstanding  it  is  the  one  thing  in  the 
world  they  have  to  do. 

Mother's  Milk  the  Best — ^Every  mother  ought,  if  possible,  to  suckle 
her  own  infant,  not  only  for  her  own  sake  but  for  that  of  the  child. 
Statistics  show  that  babies  nursed  by  their  mothers,  amid  the  unfavor- 
able surroundings  of  prison  life,  thrive  better  than  those  who  are  brought 
up  by  hand  in  healthy  country  districts  outside,  and  no  woman  in  good 
health,  who  can  furnish  the  nourishment,  should  be  spared  the  reproach 
of  risking  the  life  and  health  of  her  ofi'spring  if  she  refuses  to  perform 
her  maternal  duties  in  this  regard.  A  mother  undertaking  the  suck- 
ling of  her  infant  should,  moreover,  do  so  with  a  mind  fully  alive  to 
its  importance,  and  with  a  firm  determination  that  no  pleasi:res  of  society 
or  of  fashion  shall  interfere  with  its  conscientious  performance,  or  else 
she  had  better  not  attempt  it  at  all. 

Amount  of  Breast  Milk — The  amount  of  milk  contained  in  the  breast, 
especially  with  the  first  child,  is  very  small  for  two  or  three  days,  but  in 
some  forty-eight  hours  the  rush  of  milk,  as  it  is  called  by  nurses,  com- 
mences, and  is  often  attended  with  some  fever,  and  marked  pain  and 
soreness  in  the  breasts.  The  remedy  for  this  disturbance  in  the  mother's 
system  is,  however,  very  simple  and  conveniently  at  hand,  and  as  the 
child,  which,  if  healthy  and  vigorous,  generally  has  a  good  appetite,  draws 
out  the  milk  which  nature  has  provided  for  its  special  benefit,  all  these 


MANAGEMENT  OF  TIIK  INFANT.  Y05 

uneasy  sensations  soon  subside.  If  the  coming  in  of  the  milk  is  unusually 
delayed,  it  may  be  necessary  to  give  the  baby  a  little  cow's  milk,  well 
diluted  and  sweetened  with  sugar  of  milk;  but  this  is  seldom  required. 

Mothers  to  Avoid  Excitement — During  the  time  a  mother  is  nursing 
her  infant  every  care  should  be  used  to  avoid  any  violent  mental  excite- 
ment or  shock,  which  is  exceedingly  apt  to  influence  the  secretion  of  the 
mammary  glands  to  a  certain  extent,  just  as  it  does  that  of  the  lachrymal 
gland,  and  render  the  lacteal  fluid  temporarily  unwholesome  or  poison- 
ous to  the  infant;  or  it  may  completely  suppress  the  secretion  of  milk, 
with  very  serious  consequences  to  both  the  parent  and  her  offspring. 

The  Wet  Nurse. — If,  for  any  reason,  the  mother  is  unwilling  or  un- 
able to  suckle  her  infant,  the  next  best  chance  for  the  baby's  life  is  to 
procure  a  good  wet  nurse.  When  such  an  alternative  is  adopted,  great 
care  should  be  exercised  in  selecting  the  foster-mother,  and  the  physician's 
advice  ought  always  to  be  obtained  vipon  this  important  subject. 

Bringing^  Up  by  Hand. — Should  the  mother  fail  to  nurse  her  child, 
and  no  good  wet  nurse  is  procurable,  the  child  must  be  brought  up  by 
hand,  a  species  of  manipulation  which  contributes,  it  is  probable,  more 
than  anything  else  to  swell  the  lists  of  infant  mortality  in  most  largo 
cities,  as  well  as  to  some  extent  in  country  districts.  Although  goat'"; 
milk  is  used  occasionally  in  this  country  as  an  infant's  food,  practically 
the  choice  is  narrowed  down  in  most  cases  to  cow's  milk,  and  the  great 
object  should  be  to  secure  this  from  healthy  animals,  pure  and  free  from 
all  admixture,  as  pointed  out  in  an  earlier  chapter  upon  milk  as  an 
article  of  diet,  and  in  a  perfectly  fresh  condition. 

Testing  the  Milk. — All  milk  Tised  for  the  feeding  of  young  infants, 
especially  in  the  summer,  should  be  earefiilly  tested,  and  particularly  in 
regard  to  its  acidity,  with  litmus  paper.  If  found  to  be  acid  it  ought 
to  be  at  once  rejected,  and  a  sample  of  pure,  sweet  milk  obtained. 

Putting  Baby  to  the  Breast. — A  new-born  infant  is  not  hungry,  con- 
sequently it  need  not  be  put  to  tlie  breast  for  three  or  four  hours  or 
more.  This  will  also  give  the  mother  a  chance  to  obtain  a  little  needed 
rest.  For  the  first  twenty-four  to  thirty-six  hours  the  baby  should  be 
put  to  the  breast  every  four  to  six  hours.  The  subseqiient  twenty-four 
hours  about  every  three  to  four  hours.  About  the  third  day  or  so,  when 
the  milk  is  well  established,  the  baby  sliould  be  nursed  every  two  to  three 
hours. 

Time  for  Nursing — Under  no  consideration  nurse  the  baby  between 
11  P.  M.  and  5  to  6  A.  M.  If  mothers  would  only  institute  this  from 
45 


706  DISEASES   PECULIAB   TO    WOMEN. 

the  time  of  birth,  both  she  and  the  baby  will  obtain  a  good  night's 
sleep.  Should  the  baby  awaken,  change  its  position,  and  give  it  a  little 
water  to  drink,  and  invariably  it  will  go  off  to  sleep.  Another  bad 
practice  is  to  give  the  baby  the  breast  every  time  it  cries,  in  order  to 
quiet  it.     It  should  be  conquered  from  the  beginning,  so  do  so. 

Weaning  the  Child. — The  time  for  weaning,  generally  about  the  age 
of  nine  months,  should  be  determined  partly  by  the  growth  of  the  teeth, 
presiiming,  of  course,  that  the  mother's  health  is  not  suffering  in  the 
meanwhile.  When  the  first  lower  middle  incisor  teeth  appear,  which 
usiially  hapjiens  about  the  sixth  or  seventh  month,  the  mother  may  begin 
to  diminish  the  number  of  times  for  suckling  more  rapidly,  at  the  same 
time  replacing  the  breast  milk,  of  which  the  infant  is  deprived,  by  cow's 
milk  thickened  with  oatmeal,  barley  or  wheet  flour,  and  so  forth.  After 
the  child  has  four  teeth  it  should  be  weaned,  although  if  the  infant  is 
feeble  or  the  season  unfavorable,  the  period  of  nursing  may  be  extended 
a  few  months  longer. 

Dilution  of  Milk — If  the  new-born  baby  is  not  nursed  and  fresh 
cow's  milk  i^  employed,  it  should  at  first  be  diluted  with  half  its  bulk  of 
pure,  tepid  water,  sweetened  with  a  teaspoonful  of  sugar  of  milk  to  one- 
quarter  of  a  pint  of  milk,  and  a  few  grains  of  salt.  Condensed  milk  will 
not  require  sweetening,  but  should  be  freely  diluted  so  as  to  resemble 
human  milk  in  color.  For  the  first  month  of  a  child's  life  it  may  be  mixed 
in  the  proportion  of  one  part  of  the  condensed  milk  to  ten  or  twelve  of 
warm  water. 

Cleanliness  of  Nursing  Bottle. — The  most  rigorous  cleanliness  of  the 
nursing  bottle  and  nipples  must  be  insisted  on,  and  imder  no  consideration 
should  the  long  rubber  flexible  tube  apparatus  be  employed.  It  is  an 
exceedingly  dirty  arrangement,  as  it  cannot  be  properly  cleaned.  Simply 
use  a  very  plain  bottle,  keeping  the  nipples  in  a  soda  solution. 

Foods  Other  than  Milk — "When  a  child  does  not  seem  to  thrive  well 
ujjon  pure  or  diluted  cow's  milk,  it  has  often  been  advised  to  resort 
speedily  to  mixtures  of  milk  with  meat  broths,  raw  eggs,  and  so  forth. 
Bretoimeau  reported,  as  early  as  1818,  that  when  children  under  his 
care  who  were  suffering  with  tabes  mesenterica,  were  fed  with  milk  and 
meat  broth,  they  rapidly  improved,  and  other  authorities  recommend  this 
mixture  as  the  next  best  thing  to  woman's  milk,  or  the  malted  milk  can 
be  tried. 


KXTEA  TTTEEINE  PEEONANCT.  Y07, 


EXTRA  UTERINE  PREGNANCY. 


This  constitutes  a  pregnancy  occurring  in  the  oviduct  and  not  in  the 
cavity  of  the  womb. 

Symptoms. — 1.  The  woman  will  have  all  the  symptoms  of  pregnancy. 
A  pregnancy  of  this  kind  invariably  follows  a  long  period  of  sterility.  The 
woman  who  has  previously  menstruated  regularly  will  miss  a  period  and 
consult  a  physician.  If  he  examines  her  to  ascertain  the  cause  of  the  stop- 
page of  the  flow,  and  this  variety  of  pregnancy  is  present,  he  will  find  the 
uterus  very  slightly  enlarged  and  a  mass  to  one  side  of  it. 

2.  About  four  to  eight  weeks,  as  the  foetus  continues  to  grow,  the  dis- 
tended tube  may  rupture,  or  the  contents  may  be  expelled  through  the  end 
of  the  tube  (tubal  abortion). 

3.  If  the  tubal  abortion  or  rupture  occurs,  the  woman  will  first  notice 
a  sudden,  sharp,  severe  pain  in  the  abdomen.  This  will  be  followed  by 
fainting  spells  which  may  or  may  not  end  in  death,  due  to  the  loss  of 
blood. 

Treatment — If  the  condition  is  recognized  prior  to  rupture,  the  wo- 
man should  submit  to  an  operation  at  once,  before  rupture  takes  place, 
which  accident  invariably  terminates  in  death. 

If  the  woman  is  not  seen  by  a  physician  imtil  rupture  does  occur  she 
should  be  operated  on  at  once,  in  order  that  the  bleeding  vessels  may  be 
tied.  In  a  few  rare  cases  nature  checks  the  bleeding,  which  will  be  fol- 
lowed by  a  second  rupture,  usually  with  fatal  results. 


PART  XI  OF  BOOK  IV 

Treats  of  the  diseases  of  the  skin,  hair  and  nails. 


Barber's  Itch    724 

Causes    724 

Precautions  in    725 

Treatment   of    725 

Brown  Patches  in  Scald  Head   727 

Boils    715 

Bunions    719 

Carbuncles    716 

Chigger 727 

Corns 719 

Diseases  of  the  Skin 711 

Eczema   713 

Erythema   711 

Flesh-worms    72a 

Freckles    720 

Herpes    714 

Impetigo     715 

Itch    727 

Disinfection   for    729 

Symptoms   of    727 

Treatment  for   728 

Itching    720 

Lice    729 

Treatment   for    729 

Lichen  717 

Moist   Tetter    713 

Nettle  Rash   713 

Pemphigus    714 

Pimples    716 

Prurigo  Symptoms  717 


Pityriasis    718 

Precautions  in  Barber's  Itch  725 

Prickly   Heat    717 

Pruritus     720 

Psoriasis     717 

Pustular  Eruption  715 

Redness  cf  the  Skin 711 

Ring-worm  of  the  Body  724 

Ring-worm  of  the  Head 723 

Scabies    727 

Scald  Head   726 

Brown  Patches  in  727 

Scalp  Disease  718 

Treatment  of   718 

Seborrhea     720 

Shingles    714 

Skin    Diseases    711 

Classes  of   711 

Due  to  Vegetable  Parasites 722 

Skin  Glands,  Diseases  of  720 

Flesh-worms    720 

Seborrhea     720 

Skin  Redness   711 

Strophulus    716 

Tetter    717 

Treatment  of   718 

Urticaria    713 

Warts    719 


ILLUSTRATIONS 


Burrow  of  Itch   Insect    729 

Eczema,   Scaly   Form    714 

Eczema,  Simple  Eruption  714 

Itch  Insect    728 


Ring-worm  on  tlic  Hair,  Effect  of.... 723 

.Sebaceous  Gland,   Magnified   721 

Scald    Head    715 

The  Skin   712 


709 


CURATIVE    MEDICINE 


PAKT   XI. 

SKIN  DISEASES 


This  class  of  affections  embraces  diseases  of  the  skin,  hair  and  nails, 
md  therefore  includes  maladies  which  occasion  much  distress  and  deform- 
ity, but  are  seldom  dangerous  to  life. 

Classes  of  Skin  Diseases — Skin  diseases  are  easily  recognized,  but 
there  is  sometimes  difficulty  in  distinguishing  between  the  different  forms. 
They  divide  themselves  thvis : 

1.  Those  of  an  eruptive  (erythematous")  character. 

2.  The  catarrhal,  in  which  the  conditions  resemble  those  belonging 
to  inflammation  of  the  mucous  membrane. 

3.  The  vesicular,  which  is  composed  of  small  blisters. 

4.  The  pustular,  made  up  of  pustules  or  small  boils,  containing  pus 
or  matter. 

5.  The  papular,  in  whick  pimples  appear,  containing  neither  water 
nor  pus. 

6.  The  scaly  eruptions  in  which  the  affected  parts  are  covered  with 
dry,  whitish  layers  of  epithelial  cells. 

7.  Skin  diseases  caused  by  animal  or  vegetable  parasites,  of  which  the 
itch  is  a  remarkable  illustration. 

SKIN  REDNESS   (Erythema). 

Symptoms — Erythema  is  the  name  applied  to  the  redness  due  to  ii 
superficial  inflammation  of  the  skin.  It  is  the  mildest  form  of  skin  dis- 
ease, and  is  apt  to  affect  fat  people  in  hot  weather.  Infants  are  liable  to 
be  affected  with  it  behind  the  joints. 

Treatment.— See  Nettle  Eash. 

(7H) 


a.  Epidermis  or  cuticle. 
h.  Dennis  or  true  sicin. 
C.      Nerve  prolongations- 


THE  SKIN 


712 


d.  Blood-vesseli. 

e.  Oil  cells. 
/.      Glands. 


ECZEMA.  713 


NETTLE  RASH  (TJrticaria) , 

Symptoms — This  is  an  eruptive  affection  which  sometimes  comes  out 
quite  suddenly,  and  is  attended  with  a  most  troublesome  itching.  It  is 
characterized  by  the  formation  of  ''wheals"  or  rounded  patched  of  elevated 
skin,  whiter  than  the  surrounding  parts,  which  are  slightly  reddened  at  the 
margins. 

Causes — It  may  arise  from  the  bites  or  stings  of  insects;  from  the 
eating  of  certain  fish,  especially  shellfish;  or  from  reflex  irritation,  and 
other  causes. 

Treatment. — It  is  greatly  aggravated  by  scratching,  and,  like  simple 
erythema,  is  relieved  by  dusting  with  finely-powdered  oxide  of  zinc  and 
starch,  with  lycopodium,  or  even  with  rye  flour.  Lotions  of  lead  water, 
benzoic  acid  and  borax  are  also  sometimes  useftil.  Locally  carbolic  acid, 
two  drachms;  glycerine,  two  drachms;  water,  one  pint.  Small  doses  of 
calomel,  followed  by  a  saline. 

MOIST  TETTER  OR  ECZEMA. 

Symptoms. — Eczema,  sometimes  called  moist  tetter,  is  a  catarrhal  in- 
flammation of  the  skin  usually  attended  with  a  breach  of  siirface.  It  pre- 
sents at  first  irritable,  raw,  red  patches,  with  occasional  little  blisters  which 
soon  break  and  a  fluid  is  discharged,  which  in  drying  forms  crusts  or  scabs. 
Later  on  the  patches  become  dry,  scaly,  and  often  cracked.  This  is  a 
form  of  skin  disease  which  is  often  seen  in  young  infants,  in  whom  it 
sometimes  receives  the  name  of  milk-crust.  The  pain,  burning  and  itch- 
ing of  eczema  are  intense,  and  yet  it  is  only  aggravated  by  scratching. 
It  is  especially  apt  to  appear  aboiit  the  flexures  of  the  joints,  as,  for  ex- 
ample, in  the  hollows  of  the  elbows  and  knees. 

Treatment. — Many  formulas  have  been  recommended  and  iised  for 
this  prevalent  condition.  Stimulation  of  the  skin  is  of  great  importance, 
and  various  drugs  have  been  used  for  that  purpose,  such  as  resorcin,  tar, 
camphor,  etc.  The  following  have  been  recommended  by  various  spe- 
cialists on  the  disease: 


R. — Camphor     i  drachm 

•   Oleate  zinc 2  drachms 

Powd.    starch     i  ounce 

Use  freely  as  a  dusting  powder. 


714:  SKIN    DISEASES. 

R. — Acid   boric    2  drachms 

Acid    carbolic    Vj   drachm 

Glycerine     '/i   drachm 

Water     i  pint 

Apply  twice  a  day. 

Resorcin     Vi   drachm 

Bismuth    subnitratc     2  drachms 

Glycerine     2  drachms 

Lime   water    _. 4  ounces 

Apply  two  or  three  times  daily. 

Some  cases  do  better  with  an  ointment,  when  tlie  following  may  Le 
applied : 

R. — Ichthyol I   drachm 

Pulv.   Camphor    Vi   drachm 

Zinc    ointment    I  ounce 

SHINGLES  OR  HERPES. 

Symptoms. — Herpes,  which  is  a  good  type  of  the  vesicular  affection  of 
the  skin,  is  characterized  by  little  blisters  which  come  out  in  small  groups, 
and  when  appearing  about  the  mouth  and  nose  constitute  the  cold-sores 
with  which  almost  everyone  is  familiar. 

Shingles  Proper. — A  severe  form  called  herpes  zoster,  or  the  "shin- 
gles," comes  on  with  smarting  and  burning  pain  in  a  belt  half  way  around 
the  body  of  large  patches  of  the  eruption.  It  is  distressing  and  tedious, 
often  lasting  a  month  or  six  weeks,  but  rarely  dangerous.  The  popular 
idea  that  it  will  prove  fatal  if  it  goes  all  around  the  body  is  without 
foundation. 

Treatment. — The  only  treatment  is  to  apply  anodynes  and  soothing 
lotions,  such  as  the  morphia  and  lead  water  recommended  in  erysipelas, 
and  administer  opiates  to  relieve  the  pain,  or  pil  acetanilide  comp. 

PEMPHIGUS. 

Character — Pemphigus  is  another  vesicular  eruption,  characterized 
by  the  formation  of  large  blisters,  from  half  an  inch  to  two  inches  in 
diameter,  resting  on  slightly  reddened  surfaces,  and  mostly  attended  with 
severe  itching.  These  blisters  sometimes  appear  on  the  fingers,  but  com- 
monly attack  the  lower  limbs.  They  should  be  punctured  at  once  and  borio 
acid  applied.  They  generally  indicate  a  more  or  less  impoverished  state 
of  the  system,  in  which  iron,  quinine,  strychnine  and  good  nutritious  food 
are  called  for. 


•^  «?^^ 


''^    -a 


t, 


<  z 

N  >. 


I 


I  K    T.  S. 


SCALD  HEAD  (Favus). 


BOILS.  715 

Remedy. — ^Arsenic  is  also  very  useful,  and  locally  sootliing  ointments 
or  absorbent  powders  may  be  employed. 

IMPETIGO  (Pustular  Eruption). 

Character. — Impetigo  is  the  most  common  of  the  pustular  eruptions, 
and  is  characterized  by  the  formation  of  separate  pustules,  somewhat  like 
those  of  small-pox.  They  may  attack  any  part  of  the  body,  but  are  most  apt 
to  appear  upon  the  face  and  limbs.  This  disease,  like  eczema,  which 
in  many  respects  it  resembles,  seems  as  if  it  were  an  aggravated  form  of 
impetigo,  and  is  especially  frequent  among  children,  although  adults  are 
not  exempt.  Impetigo  is  always  associated  with  general  debility,  defective 
nutrition,  or  hygienic  neglect. 

Remedies — The  treatment  is  by  good  food,  tonics,  Avith  cod-liver  oil, 
and  strict  attention  to  cleanliness.  Soothing  applications,  such  as  Gou- 
lard's cerate,  should  be  made  first  to  the  pustules,  but  later  on  a  very  mild 
mercurial  ointment  is  more  effectual.  Mild  antiseptics  or  boric  acid  can 
also  be  used. 

BOILS, 

Causes — Boils,  those  common  and  exceedingly  troublesome  inflictions 
upon  mankind,  are  classed  under  the  head  of  pustules.  With  all  the  ad- 
vances we  have  made  in  late  years  in  pathology,  the  cause  of  boils  still 
remains  undiscovered.  Sometimes  they  seem  to  be  due  to  high  living,  and 
in  other  cases  poor  diet  appears  to  determine  the  advent  of  a  troublesome 
series  of  these  parts.  One  boil  is  very  apt  to  precede  a  crop  of  fifteen  or 
twenty,  although  there  is  no  certainty  that  this  will  be  the  result. 

Treatment — 1.  The  best  way  of  managing  a  boil  is  to  poultice  it  with 
flaxseed  or  bread  and  milk,  containing  laudanum  to  ease  the  pain.  If  the 
boil  is  small,  the  poultice  may  be  spread  upon  a  piece  of  oiled  silk,  which 
prevents  it  from  becoming  dry,  and  held  in  place  by  a  bandage,  or  by  a 
square  piece  of  linen  upon  each  corner  of  wliicli  has  been  daubed  a  little 
spot  of  adhesive  plaster,  the  stick  of  plaster  being  melted  in  the  Hame  of 
a  candle  for  the  purpose.  This  holds  a  dressing  of  any  kind  on  a  broad, 
flat  surface  of  the  body,  as,  for  instance,  the  skin  of  the  back,  very  satis- 
factorily. 

2.  When  the  boil  softens  in  the  centre,  and  the  fluctuation  of  matter 
can  be  detected,  or  its  yellowish  color  can  be  seen  under  the  skin,  some 
twenty-four  hours  of  suffering  may  be  saved  by  Laving  it  lanced,  and  the 
pain  of  the  cut  may  be  abolished  by  freezing  the  surface  with  ether  spray, 


716  SKIN    DISEASES. 

or  by  stroking  it  with  a  little  bag  containing  a  mixture  of  ice  and  salt.  In 
certain  eases  it  is  important  to  lance  a  boil  early,  so  as  to  prevent  the  bur- 
rowing of  the  pus  toward  sonic  important  structure;  but  ordinarily,  if  the 
sufferer  dreads  the  knife,  there  is  uo  actual  necessity  for  using  it,  and  the 
boil  may  safely  be  left  to  break  of  its  own  accord,  under  the  poultice,  one, 
two  or  three  days  later  than  the  time  when  it  is  ripe  for  lancing. 

3.  Lancing  the  little  pimple,  with  which  a  boil  first  commences, 
exactly  through  the  middle,  which  can  be  done  almost  painlessly  under 
the  ether  spray,  will  nearly  always  ci:t  short  this  troublesome  affection. 
Ten  or  twelve  grains  of  quinine  daily,  so  as  to  j^roduce  slight  cinchonism 
for  a  week,  occasionally  breaks  up  a  course  of  boils,  but  is  by  no  means  an 
infallible  remedy. 

CARBUNCLES. 

Character. — Carbiuicles  chiefly  differ  from  boils  in  the  larger  area  in- 
volved in  the  inflammation,  from  which  a  core  of  dead  connective  tissue, 
called  a  "slough,"  several  inches  in  diameter,  may  come  away.  Car- 
buncles are  apt  to  come  on  the  nape  of  the  neck,  and  on  the  back,  but  may 
appear  on  any  part  of  the  body.  A  large  carbuncle  will  sometimes  keep 
a  patient  in  bed  for  a  month  or  six  weeks,  and  the  pain  and  exhausting 
discharge  wears  out  the  strength  so  much  that  it  may  cause  death ;  if  a 
second  of  large  size  appears,  after  the  first  begins  to  heal,  as  it  is  not  very 
unusual,  it  quite  frequently  proves  fatal. 

Treatment. — Poultices  of  flaxseed  meal,  bread  and  milk,  powdered 
slippery  elm  bark,  or  of  yeast ;  anodynes  to  relieve  pain ;  and  twelve  grains 
of  quinine  daily,  with  tincture  of  iron  to  support  the  strength,  constitute 
the  appropriate  treatment.  Early  and  free  incisions  into  the  inflamed 
tissue,  made  after  freezing  the  part,  are  of  great  service.  After  opening 
apply  equal  parts  of  carbolic  acid  and  glycerine. 

PIMPLES. 

The  papules  or  pimples  are  solid  elevations  of  the  skin,  containing 
neither  water  like  the  vesicles,  nor  pus  like  the  pustules.  They  are  three 
in  number,  including  strophulus,  the  red  gum  or  tooth-rash  peculiar  to 
infants,  lichen   or  prickly  lieat  and  prurigo. 

Strophulus. — This  consists  of  an  eruption  of  innumerable  small,  red- 
dish pimples,  which  occur  for  the  most  part  on  the  face,  neck  and  arms  of 
young  children.  The  irritation  and  general  disturbance  is  slight.  The 
eruption  is  usually  caused  by  digestive  derangement  of  .some  kind,  as,  for 


PSORIASIS.  717 

instance,  that  of  cutting  a  tooth,  and  passes  away  with  the  cessation  of  ita 
cause. 

Treatment — The  only  treatment  necessary  is  some  mild,  saline  laxa- 
tive, and  a  lotion  of  very  weak  solution  of  carbonate  of  soda,  five  or  ten 
grains  to  the  ounce,  with  a  teaspoonful  of  glycerine,  to  allay  the  itching  if 
that  appears  to  be  very  troublesome. 

Prickly  Heat  or  Lichen.— This  is  very  common  in  hot  weather,  in  the 
simple  form  of  reddish  pimples,  which  itch  a  great  deal  but  usually  sub- 
side on  the  approach  of  the  cooler  season.  It  sometimes  takes  on  a  severe 
form,  and  may  even  become  chronic. 

Treatment. — In  mild  cases  tepid  baths,  plain  and  easily  digested  food, 
an  occasional  saline  laxative,  with  a  tablespoonful  of  infusion  of  gentian, 
and  five  grains  of  bicarbonate  of  potash  or  soda  internally,  three  times 
daily,  will  effect  a  cure.  To  relieve  the  itching,  solutions  of  borax,  vine- 
gar or  carbolic  acid  may  be  used  with  advantage.  In  aggravated  cases 
the  more  powerful  tonics,  with  tablespoonful  doses  of  cod-liver  oil  and  one- 
sixteenth  of  a  grain  of  arsenic  three  times  a  day  must  be  resorted  to. 

Prurigo  Symptoms — This  is  characterized  by  an  eruption  of  pale, 
slightly  elevated  pimples,  most  situated  on  the  trunk  of  the  body,  and 
attended  with  very  intense  irritation,  especially  at  night,  so  that  the  marks 
made  by  the  patient's  nails  in  scratching  can  almost  always  be  seen,  and 
aid  in  recognizing  the  malady.  It  is  frequently  the  result  of  the  presence 
of  the  vermin  with  which  so  many  dirty  people  are  infested. 

Remedies — Cleanliness,  by  the  aid  of  strong  alkaline  baths,  and  the 
use  of  an  ointment  of  carbolic  acid,  or  if  white  precipitate,  with  the 
administration  of  tonics  and  good  food  will  generally  effect  a  cure.  Some- 
times, however,  the  disease,  unless  it  is  carefully  treated  early,  proves  very 
obstinate,  being  kept  up  in  great  measure  by  the  constant  scratching, 
which  it  is  very  difficult  for  the  patient  to  abstain  from. 

PSOHIASIS  (Tetter). 

Character. — Psoriasis  is  the  most  important  scaly  eruption;  in  certain 
of  its  varieties  it  probably  constituted  one  form  of  the  leprosy  of  the 
Bible.  It  is  characterized  by  the  appearance,  at  first,  of  oval  or  rounded 
patches  of  slight  irritation,  tlien  upon  these  an  eruption  of  scales,  which 
grow  dense  and  white  toward  the  centre.  Afterward  the  spot  expands 
from  its  outer  edge,  where  the  skin  is  often  reddened  and  slightly  raised 
above  the  level  of  the  surrounding  surface.     This  is  the  skin  disease  to 


718  BKIN  DISEASES. 

which  the  name  of  "dry  tetter"  is  commonly  applied.  In  the  worst  or  in- 
veterate form,  the  whole  body  may  be  covered  with  these  white  scales,  ex- 
cept the  face,  the  palms  of  the  hands  and  the  soles  of  the  feet.  Even  these 
do  not  always  escape.  The  incrustation  of  scales  in  this  variety  of 
psoriasis  is  thick  and  dense.  When  it  has  lasted  for  some  time,  the  skin 
chaps  and  breaks,  after  which  there  is  severe  soreness  with  exudation  of 
fluid  from  the  broken  surface,  intense  irritation  and  itching,  with  great 
general  and  physical  exhaustion,  lasting  for  many  weeks,  or  perhaps 
months.  In  rare  cases  it  may  even  prove  fatal.  In  the  milder  form,  it  is 
especially  apt  to  appear  very  symmetrically  upon  the  knees  and  elbows, 
and  is  most  common  between  the  fifteenth  and  twenty-fifth  year  of  life. 
It  is  prone  to  recur  in  a  patient  who  has  once  manifested  it,  but  is  not 
contagious.  Often  it  is  hereditary,  and  may  be  associated  with  a  gouty 
or  rheumatic  taint  in  the  system. 

Treatment.- — The  treatment  consists  of  careful  attention  to  diet,  avoid- 
ance of  alcoholic  stimulants,  and  the  administration  of  arsenic  in  the  form 
of  Fowler's  solution,  five  drops  thrice  daily.  Externally  soothing  lotions 
or  ointments  are  required  in  the  first  stage,  and  mild  mercurial  or  tar 
ointments  are  of  service  after  it  has  become  chronic. 

R. — Ol   cade i  drachm 

Lanoline     i  ounce 

Apply  twice  daily. 

R. — Tar    ointment     I  drachm 

Petrolatum    I  ounce 

Apply  twice  daily. 

R. — Chrjsarobin     15  grains 

Lanoline     I  ounce 

Apply  to  each  spot  twice  daily. 

PITYRIASIS    (Scalp   Disease). 

Character. — i'ityriasis  is  a  squamous  disease  especially  apt  to  affect 
the  scalp  when  it  appears  in  the  milder  form,  giving  rise  to  the  shedding 
of  an  immense  number  of  bran-like  scales,  resembling  an  exuberant  crop  of 
dandruff. 

Treatment. — The  condition  of  the  health  in  general  should  be  looked 
after.  Iron  and  arsenic  are  given,  also  calcium  sulphide  locally  for  the 
scalp. 


WABTS,  CORNS  AND  BUNIONS.  719 

^■—Tt  green   soap    4  ounces 

Alcohol     2  ounces 

Dilute  and  use  as  a  shampoo,  if  crust  or  scales.     After  removal  apply 

R.— Sulphur    precip i   drachm 

Salicylic    acid    10  grains 

Petrolatum     i  ounce 

Or, 

R-— Tr    Cantharide     3  drachms 

Tr   capsicum    3  drachms 

Castor    oil     2  drachms 

Bay  rum  3  ounces 

"WARTS,  CORNS  AND  BUNIONS. 

Hypertrophies  of  the  skin  are  all  unusual  diseases,  except  warts  and 
corns,  which  are  common  enough  to  make  up  for  all  the  rest.  The  com- 
ing and  going  of  warts  on  the  hands  is  as  much  a  mystery  now  as  in  former 
ages,  when  the  most  ridiculous  remedies  were  gravely  prescribed. 

Wart  Remedy. — Warts  can  be  destroyed  by  caustics,  of  which  nitric 
acid  is  the  most  severe  and  effectual,  and  chromic  acid  perhaps  the  least 
painful.  When  arising  from  the  poison  of  syphilis,  they  are  sometimes 
extremely  sore  and  troublesome,  so  much  so  as  to  require  removal  by  sur- 
gical operation. 

Causes  and  Treatment  of  Corns.— Corns  are  similar  to  warts  in  their 
structure,  except  that  they  have  a  much  thicker  layer  of  epidermis  over 
their  surface.  They  are  almost  always  produced  by  the  pressure  of  tight 
shoes,  and  may  be  avoided  by  caution  in  this  respect.  They  can  usually  be 
prevented  from  giving  much  trouble  by  carefully  trimming  out  the  centre 
of  the  corn  at  short  intervals,  or  by  wearing  one  of  the  varioiis  forms  of 
perforated  corn-plasters  in  common  use.  In  cutting  corn,  the  incision 
should  never  go  through  the  epidermis,  so  as  to  cause  bleeding,  since  dan- 
gerous inflammation  has  thereby  been  set  up. 

R. — Salicylic   acid    %  drachm 

Ex.  Cannabis    Ind 10       grains 

Collodion     4       drachms 

Apply  daily  for  3  or  4  days  when  the  callous  can  be  removed. 

Bunion  Treatments — A  bunion  is  generally  made  up  of  a  corn  on  the 
Bide  of  the  great  toe,  and  an  irritated  synovial  sac  or  bursa  beneath  it. 
It  is  also  the  result  of  wearing  too  tight  a  shoe,  especially  such  as  are  too 
narrow  at  the  point.  When  inflamed,  it  should  be  soothed  with  lead  water 
and  laudanum ;  a  loose  shoe,  or  one  with  a  piece  cut  out  of  the  side,  being 
!Wom.    After  the  reduction  of  tke  inflammation,  benefit  may  be  obtained 


720  SKIN    DISEASES. 

hj  painting  with  tincture  of  iodine.  A  bunion  should  never  be  neglected, 
as  it  is  liable  to  suppurate,  leaving  a  troublcsonio  indolent  sore,  which  may 
for  years  cripj)le  the  patient,  even  if  permanent  lameness  does  not  result. 

PRURITUS  (Itching). 

Character. — Pruritus  is  a  very  common  disease  of  the  skin,  which  is 
characterized  by  itching  without  any  eruption  or  other  apparent  change  in 
the  appearance  of  the  part  affected.  Children  and  elderlv  people  arc  par- 
ticularly apt  to  suffer  thus,  and  the  localities  involved  are  generally  those 
about  the  orifices  of  the  body. 

Causes Sometimes,  like  prurigo,  it  may  be  traced  to  the  irritation 

caused  by  vermin,  usually  the  pediculus  corporis  or  body-louse,  which  may 
be  gotten  rid  of  by  attention  to  cleanliness  and  the  application  of  weak 
mercurial  ointment,  a  tincture  of  larkspur,  or  various  other  home  rem- 
edies. AYheu  not  thus  produced,  the  cause  must  be  sought  in  some  de- 
terioration of  the  general  h.ealth. 

Treatment As  local  applications,  lotions  of  borax,  half  an  ounce  to 

the  pint,  or  of  carbolic  acid,  one  or  two  teaspoonfuls  to  the  pint,  and  oint- 
ments of  zinc  camphor,  belladonna  or  morphia  are  useful. 

FRECKLES. 

Freckles  consist  of  a  deposit  of  oxide  of  iron  from  the  blood,  just 
beneath  the  epidermis  or  in  its  lower  layers.  They  may  often  be  dissi- 
pated by  painting  with  tincture  of  iodine  or  frequent  application  of  per- 
oxide of  hydrogen. 

DISEASES  OF  SKIN  GLANDS. 

Seborrhea. — In  seborrhea  there  is  an  excessive  production  of  secre- 
tion, made  up  of  oily  matter  and  cast-off  epithelial  cells,  which  accumu- 
lates upon  the  surface  in  the  form  of  thin,  j-ellowish  scales.  It  is  especially 
common  on  the  skin  of  young  infants. 

Treatment. — The  layers  of  scales  may  be  removed  by  the  use  of  white 
eastile  soap  and  warm  water,  and  if  there  is  no  inflammation  of  the  skin, 
a  mild  carbolic  or  white  precipitate  ointment  may  be  used  to  prevent 
their  return. 

Flesh-worms. — Acne,  commonly  called  pimples  or  flesK-worms,  com- 
ing, as  it  does,  upon  the  face  just  at  the  time  when  young  people  of  both 
sexes  begin  to  feel  most  anxious  about  their  personal  beauty,  gives  rise 


DISEASES  OF  SKIN  GT-ANDS 


721 


to  a  far  greater  amount  of  unbappiness  than  many  of  the  serious  mala- 
dies to  which  flesh  is  heir.  It  is  an  inflammation  of  the  sebaceous  glands 
of  the  skin  upon  the  face  and  back,  and  elsewhere,  which  comes  on  in 
successive  crops,  and  gives  rise  to  the  spotted  and  pimply  countenances 
which  are  often  so  unsightly  or  even  repulsive. 

Description. — These  sebaceous  glands,  one  of  which  is  well  delineated 
in  the  accompanying  wood-cut,  are  generally  situated,  as  there  indicated, 

by  the  side  of  a  hair,  and  if  in- 
flamed, caused  by  the  pressure 
they  exert  when  distended,  an  in- 
flammation of  the  surrounding 
dorm  constituting  the  pimple  of 
acne.  In  the  figure  is  exhibited 
a  hair  in  its  follicle,  highly  mag- 
nified. At  Y  and  8  appear  the 
curious  little  muscles  which  have 
the  power  of  erecting  the  hair  in 
conditions  of  sudden  fright  or 
horror.  They  are,  as  is  well 
known,  much  more  active  in  ani- 
mals— for  instance,  the  cat — 
than  in  mankind.  9  and  10  in- 
dicate a  large,  and  11  a  small,  se- 
baceous gland,  both  opening  on 
the  skin  by  the  side  of  the  shaft 
of  the  hair  at  12.  The  small, 
black  spot  generally  visible  near 
the  centre  of  an  acne  pimple  is 
popularly  supposed  to  be  the 
head  of  a  flesh-worm,  which  can 
be  squeezed  out  by  pressure  at 
the  sides  of  the  papule.  In 
reality,  however,  the  yellow 
thread  which  looks  like  the  body 
of  a  worm,  is  only  the  hardened 
secretion  of  a  sebaceous  gland, 
the  top  of  which,  being  exposed  to  the  air,  has  collected  dust  and  dirt, 
and  so  become  black. 

Treatment. — Ko   advantage   is  gained   by   squeezing  out   these   little 
46 


A  Magnified   Sebaceous   Gland. 


723  BKIN    DISKABKS. 

plugs  of  fatty  matter,  as  in  most  cases  tlie  bruising  of  the  parts  more 
lliau  compensates  for  any  benefit  afforded  by  the  relief  of  internal  pres- 
sure in  the  pimple  from  retained  secretion.  A  great  many  local  applica- 
tions for  the  cure  of  acne  are  offered  for  sale,  some  of  which  are  com- 
posed of  powerful  poisons,  and  are  liable  to  do  great  and  permanent  in- 
jury. A  safe  and  often  useful  lotion  is  made  of  precipitated  sulphur, 
variously  combined  with  mucilage  of  sassafras-pith,  glycerine  and  cam- 
phor ;  or  an  ointment  of  precipitated  sulphur,  with  vaseline,  a  drachm  to 
the  ounce,  or  white  precipitate  with  vaseline,  half  a  drachm  to  the  ounce, 
may  be  employed. 

Accessory  Treatment — The  most  important  part  of  the  treatment  is 
attention  to  any  general  derangement  of  health,  especially  of  the  diges- 
tive apparatus,  or,  in  females,  of  the  menstrual  function.  Internally 
one-quarter  grain  of  calcium  sulphide  three  or  four  times  a  day  is  often 
beneficial. 

Diet. — Errors  in  diet  will  often  bring  out  a  crop  of  acne,  and  articles 
of  food  which  contain  fried  butter  or  fat  of  any  kind,  appear  to  be  apt  to 
have  this  effect.  Pastry  of  all  varieties,  particularly  mince-pie,  buck- 
wheat and  other  hot  cakes,  sausage,  cheese  and  nuts  should  all  be  avoided, 
as  well  as  spirituoiis  and  malt  liquors  in  every  form.  Although  the  treat- 
ment and  hygienic  care,  as  thus  advised,  will  generally  diminish  the  ac- 
tivity of  the  eruption,  they  may  not  always  effect  a  cure,  and  consolation 
must  be  sought  in  the  fact  that  it  seldom  persists  unless  kept  up  by  im- 
prudence, after  the  period  of  maturity  in  the  organism  has  been  attained. 

SKIN  DISEASES  DDE  TO  VEGETABLE  PARASITES, 

Causes. — It  is  now  generally  admitted  that  the  fungus  growths  found 
so  constantly  in  and  among  the  epithelial  scales  of  the  epidermis  are 
the  causes,  and  not  the  mere  accompaniments,  of  a  curious  group  of 
skin  maladies.  The  development  of  fungus  not  only  invades  the  skin, 
but  affects  also  the  hair  and  the  hair-follicles.  Though  the  variety  of 
vegetable  growth  differs  in  the  different  diseases,  each  presents  the  same 
general  features,  consisting  of  microscopic  threads  nam»d  mycelium,  cor- 
responding to  the  stem  of  a  larger  plant  like  a  grape-vine,  and  micro- 
scopic seeds  sometimes  produced  in  bunches  like  grapes,  and  called  spores. 
The  full  recognition  of  the  fact,  as  it  is  believed  to  be  by  the  present 
writer,  that  the  fimgous  growth  is  the  essential  cause  of  the  whole  disease 
ifi  vitally  important,  because  upon  it  depends  the  system  of  preventing 


BnTG-WORM   OF   THE  nBAD. 


723 


these  maladies  from  spreading  to  healthy  persons,  by  total  destruction  of 
the  spores  or  seeds  of  the  respective  diseases. 

A  Case  in  Point — In  the  instance  of  a  member  of  the  author's  family, 
a  little  girl  -was  infected  with  the  fungus  of  Favus  just  underneath  the 
tip  of  her  chin,  probably  from  spores  left  by  some  diseased  child  on  the 
sill  of  a  car  window,  from  which  she  had  been  looking  out,  and  at  the 
time  of  being  attacked  with  this  complaint,  which  was  fortunately  rec- 
ognized at  once,  and  put  an  end  to  by  appropriate  treatment,  she  was  in 
perfect  health. 

Hing-worm:  of  the  head. 

Symptoms. — Tinea  tonsurans  or  ring-worm  of  the  head  is  the  most 
common  of  these  vegetable  parasitic  diseases.  It  shows  itself  as  a  dry, 
scaly  patch,  rounded  or  oval  in  outline,  which  gradually  grows  larger 
and  larger,  the  hairs  dying  and  dropping  out  at  the  centre,  so  that 
ultimately  a  bald  spot  of  from  half  an  inch  to  two  inches  in  diameter  is 
left.  The  same  fungus  which  produces  this  malady 
in  the  head  sometimes  develops  among  the  hair  of  the 
beard,  producing  what  is  called  tinea  sycosis  or  bar- 
ber's itch,  and  upon  the  other  parts  of  the  body  where 
it  is  denominated  tinea  circiuata  or  common  ring- 
worm, with  which,  however,  no  worm  has  anything 
to  do. 

Further  Symptoms — Ring-worm  of  the  scalp  com- 
mences usually  as  a  little  plmjjle,  which  soon  spreads 
and  takes  on  its  characteristic  ring-like  appearance, 
showing  a  circle  of  minute  scales,  jjimples  and  vesicles 
at  the  circumference  of  the  patch.  As  the  disease  ad- 
vances the  hairs  included  in  the  circle  become  dull, 
dry,  twisted  and  easily  broken  off,  whilst  the  epider- 
mis and  stumps  of  the  hairs  become  covered  with  a 
The  Effect  of  Ringworm  greyish-white  powder,  consisting  chiefly  of  the  vege- 

oa   the   Hair.  . 

table  growth. 

Illustration If  one  of  these  broken  hairs  is  put 

into  a  drop  of  caustic  potash  solution,  and  examined  imder  a  high  power, 
such  as  250  diameters  of  the  microscope,  its  shaft  can  be  Seen  as  repre- 
Bented  in  the  figure,  penetrated  ■with  the  mycelium  of  the  fungus,  called 
the  tricophyton  tonsurans,  and  floating  around  may  often  be  detected 
separate  spores  of  the  same  plant  as  indicated  at  the  upper  part  of  the 
wood-cut  on  bfith  sides  of  the  hair. 


724  SKIN  DISEASES. 


EING-WORM  OF  THE  BODY. 

Tinea  circinata,  which  is  also  denominated  herpes  circinatiis  and 
ring-worm  of  the  body,  begins  like  that  upon  the  head  with  a  siiiail 
pimple,  but  soon  spreads  with  great  rapidity,  and  the  rings  of  eruption 
may  attain  a  diameter  of  four  or  five  inches. 

Characteristic — The  great  characteristic  by  which  this  affection  can 
almost  always  be  recognized  is  its  healing  up  in  the  middle,  so  that  the 
appearance  is  presented,  after  a  time,  of  a  patch  of  healthy  or  slightly 
reddened  skin,  surrounded  by  an  angry,  red  ring  about  a  quarter  of  an 
inch  wide.  Such  an  arrangement  of  the  eruption  is  peculiar  to  ring-worm 
and  suggests  that  the  fungus  in  its  growth  at  the  centre  of  the  ring  has 
exhausted  some  material  found  in  the  skin  which  is  necessary  for  its  de- 
velopment. "Were  this  not  the  case  it  would  almost  certainly  continue  to 
flourish  in  the  middle,  as  well  as  at  the  edges,  so  that  the  course  of  ring 
worm  affords  a  strong  argument  in  favor  of  that  part  of  the  germ  theory 
which  supposes  that  the  immunity  conferred  by  one  attack  of  small-pox, 
for  instance,  is  due  to  the  exhaustion  in  the  entire  system  of  some  in- 
gredient necessary  to  the  growth  of  the  specific  small-pox  fungus. 

BARBER'S  ITCH. 

Character. — Tinea  sycosis,  or  barber's  itcli,  is  the  variety  of  the  dis- 
ease in  which  its  vegetable  cause  happens  to  develop  upon  the  chin  of 
an  adult,  male  patient.  A  great  amount  of  irritation  is  usually  set  up, 
perhaps,  from  the  roots  of  the  hairs  constituting  the  beard,  extending 
more  deeply  into  the  substance  of  the  true  skin,  and  the  plant  therefore 
producing  a  deeper-seated  inflammation  of  the  parts  as  it  grows  down 
along  the  sides  of  the  hair-follicles,  than  in  the  non-hairy  portions.  Hence 
large  papules,  and  even  pustules  resembling  those  of  acne  in  its  aggra- 
vated state,  are  apt  to  be  formed,  and  the  itching  and  burning,  as  well 
as  the  disfigurement,  are  occasionally  very  troublesome  to  the  patient. 
Perhaps  among  the  vegetable  parasitic  diseases  there  is  none  to  which 
persons  are  more  liable  to  be  exposed  than  this  tinea  sycosis  or,  as  it  is 
.commonly  called,  the  barber's  itch. 

Causes. — As  before  observed,  any  one  of  the  innumerable  epidermic 
scales,  continually  shed  from  human  integument  and  constantly  floating 
in  the  atmosphere  around  us,  whence  they  are  deposited  with  other  ma- 
terials in  the  form  of  dust,  may  be  freighted  with  spores,  or  seeds  enough 


725 

of  tlie  fungus  which  causes  tinea,  to  infect  thirty,  forty  or  fifty  individuals 
should  they  meet  with  proj^er  conditions  for  growth  and  reproduction.  If 
persons  fully  realize  this  truth  they  can,  of  course,  readily  understand 
that  all  the  ordinary  precautions  usually  resorted  to  in  barber's  saloons, 
to  W'it,  those  of  having  separate  cups,  razors  and  brushes  for  each  indi- 
vidual customer  only  diminish  the  danger  of  infection,  and  by  no  means 
insure  a  certainty  of  escaping  the  disease.  For  not  only  is  the  air  of  the 
room  liable  to  carry  separate  epidermic  scales,  which  may  each  convey 
the  infection,  but  many  of  the  operations  connected  with  the  process  of 
shaving  are  still  more  likely  to  be  the  means  of  communication.  For 
instance,  the  razors  which  are  employed,  even  if  they  be  individual  prop- 
erty, are  all  sharpened  with  the  same  strap,  upon  which  may  have  been 
spread,  a  few  moments  before  you  enter  to  be  shaved,  a  few  score  epi- 
thelial cells  from  a  case  of  tinea,  one  or  two  of  which,  should  they  acci- 
dentally adhere  to  the  surface  of  your  razor,  as  it  certainly  is  quite  pos- 
sible for  them  to  do,  would  be  amply  sufficient  to  implant  the  disease 
upon  your  face.  In  like  manner  the  towels  which  are  used,  the  brushes 
and  combs,  and  even  more  certainly  the  hand  of  the  barber  himself,  may 
prove  the  most  efficient  carriers  of  contagion  which  could  possibly  be 
devised. 

Precautions — In  order  to  prevent  the  spread  of  these  vegetable  para- 
sitic diseases  the  precautions  already  suggested  must  be  rigidly  enforced. 
All  articles  of  clothing  which  have  been  worn  in  contact  with  parts  of  the 
body  where  the  parasite  grows  should  be  purified  by  immersion  in  boiling 
water,  or,  if  the  nature  of  the  material  does  not  permit  this,  by  baking  at 
a  heat  of  250°  Fahrenheit.  All  bed  linen,  bandages,  brushes,  combs  and 
towels,  or  other  articles  suspected  of  similar  contact,  should  be  treated  in 
the  same  way;  and,  of  course,  should  be  used  by  no  other  person  until 
thus  purified.  The  patient,  if  a  child,  should  be  kept  by  itself  as  far  as 
possible,  and  those  having  charge  of  the  case  should  thoroughly  wash 
themselves  after  handling  the  parts  affected.  It  is  probable  that  the  use 
of  a  strong  carbolic  acid  soap,  or  of  sulphite  of  soda  or  chlorinated  soda 
solution  would  add  to  the  security  against  attack,  and  with  such  pre- 
cautions there  is  little  danger  that  the  malady  will  be  transferred  to 
others.  Of  course  after  proper  treatment  has  once  been  put  into  opera- 
tion, the  danger  of  infection  is  still  further  diminished. 

Treatment. — 1.  The  essential  point  in  treatment  is  to  apply  to  the 
roots  of  the  hairs  a  preparation  which  will  kill  the  fungus,  just  as  weeds 
are  destroyed  in  an  asparagus  bed  by  sowing  the  ground  with  salt.     In 


726  SKIN  DISEASES. 

order  to  do  this,  the  hair — if  any  exists — should  first  be  removed,  and 
llie  surface  made  as  clean  as  possible.  When  the  hair  is  not  very  thick, 
(ir  has  already  been  nearly  destroyed  by  the  disease,  a  cure  may  perhaps  be 
effected  by  lotions  or  ointments  of  suljihuric  acid,  carbolic  acid  or  sali- 
cylic acid.  An  ointment  of  verdigi'is  is  a  favorite  home  remedy,  and 
often  succeeds  after  causing  a  good  deal  of  unnecessary  irritation. 

2,  Tincture  of  iodine,  applied  twice  a  day  for  fourteen  days,  and 
the  spot  then  covered  with  the  ointment  of  corrosive  sublimate,  of  about 
two  grains  to  the  ounce,  is  an  effectual  method  of  treatment,  which  may 
be  employed  with  great  caution  in  obstinate  cases,  or  the  following  solu- 
tion applied  at  night :  Hyposulphite  of  soda,  one  drachm ;  water,  one 
ounce.  Where  the  hair  is  very  thick  and  strong  it  is  sometimes  necessary 
to  pull  it  out  with  tweezers,  as  will  be  directed  in  speaking  of  favus,  al- 
though this  severe  operation  is,  hapjiily,  not  often  required. 

SCALD  HEAD. 

Character. — Tinea  favosa  or  favus,  called  also  scald  head  and  honey- 
comb ring-worm,  is  characterized  by  its  peculiar  dry,  sulphur-yellow 
crusts,  in  the  form  of  little  cups  about  a  quarter  of  an  inch  in  diameter. 
In  advanced  cases,  however,  these  cups  run  together,  so  that  their  well- 
defined  form  can,  perhaps,  with  difficulty,  be  recognized,  except  at  the 
edge  of  a  patch.  A  peculiar  mouse-like  odor  is  emitted  from  a  child's 
head  bearing  a  good  crop  of  favus,  this  being  probably  produced  by  the 
spores  of  the  fungus  coming  in  contact  with  terminal  branches  of  the 
olfactory  nerve  of  the  observer.  On  careful  inspection,  each  cup  is  usually 
seen  to  surroimd  a  hair,  and  there  Is  commonly  little  trouble  in  detecting 
the  fungus  spores  and  mycelia  on  microscopic  examination. 

Causes. — Although  this  disease  is  more  frequently  met  with  upon 
the  heads  of  neglected,  ill-nourished  children  than  elsewhere,  there  is 
little  doubt  that  any  one  of  these  spores  of  the  achorion  schoenleinii,  as 
the  fungous  cause  is  denominated,  might,  under  favorable  circumstances, 
germinate  and  give  rise  to  an  abundant  crop  of  favus  in  the  hair,  beard, 
or  skin  of  the  most  vigorous  individual  upon  whom  they  happened  to  be 
deposited. 

In  some  cases  the  fungus  of  favus  attacks  the  nails,  developing  be- 
neath them  and  by  the  pressure  which  it  causes  producing  their  absorption 
and  perforation.  Much  local  inflammation  about  the  root  of  the  nail  is 
lUxoB  set  up. 


ITOH  (scabies).  727 

Treatment. — The  treatment  of  faviis  consists  in  removins  the  crusts 
by  softening  with  a  poultice,  cutting  or  shaving  oil  the  hair,  and  then 
rubbing  in  thoroughly  sulphur  or  tar  ointment.  If  the  spot  is  small  a 
weak  solution  of  corrosive  sublimate  may  bo  painted  over  it,  but  this 
powerful  poison  requires  very  careful  management.  In  obstinate  cases  it 
may  be  necessary  to  pull  out  the  hair,  either  by  the  process  of  avulsion, 
where  a  cap  made  of  adhesive  plaster  is  suddenly  torn  oil  the  head,  bring- 
ing the  hair  with  it,  or  by  extracting  six  or  eight  hairs  at  a  time  with 
tweezers.  This  latter  operation,  called  epilation,  is  denominated  by  Sir 
E.  Wilson  "the  purgatory  of  avulsion,"  and  condemned  as  little  loss  cruel. 

Brown  Patches. — Tinea  versicolor  or  chloasma  depends  on  the  growth 
in  the  epidermis  of  a  fungus  similar  to  that  of  ring-worm,  but  bearing  its 
spores  in  heaps  like  bunches  of  grapes.  The  disease,  which  is  seldom 
troublesome,  is  characterized  by  brownish-yellow,  slightly  scaly,  irregular 
patches,  which  appear  on  the  front  of  the  chest  and  sides  of  the  neck.  It 
may  also  affect  other  parts  of  the  body.  As  it  does  not  penetrate  deeply 
into  the  epidermis  it  is  easily  cured  by  painting  with  tincture  of  iodine, 
tincture  of  chloride  of  iron,  gr  solution  of  sulphurous  acid. 

ITCH  (SCABIES  OR  CHIGGER). 

Causes. — Scabies  or  the  itch,  the  most  important  skin  disease  caused 
by  an  animal  parasite,  was  called  in  former  times,  when  its  true  cause  was 
but  little  understood,  the  seven-years'  itch,  because  it  was  so  hard  to  cure. 
At  present  it  is  universally  admitted  that  the  whole  cause  of  this  most 
annoying  malady  is  the  itch  insect,  or  itch-mite,  which  is  represented  in 
the  cut  on  the  next  page  as  it  appears  under  the  microscope  if  laag-nified 
about  two  hundred  diameters.  From  the  irritation  sot  up  by  the  parasite, 
and  still  more  from  the  scratching  to  which  it  drives  the  unfortunate  pa- 
tient, vesicles,  pimples  and  pustules  are  formed  and  grouped  together  in 
every  variety. 

Symptoms. — 1.  The  itching,  which  is  terribly  severe  even  in  daytime, 
is  generally  much  worse  at  night  after  becoming  warm  in  bed.  The  fa- 
vorite haunts  of  the  insect  upon  its  human  domain  are  the  hollows  of 
the  elbows  and  knees,  the  front  of  the  wrist  and  the  backs  of  the  hands 
just  below  the  roots  of  the  tingers ;  but  it  is  also  found  in  other  portions 
of  the  body  where  the  skin  is  tender.  The  palms  of  the  hands  and  the 
soles  of  the  feet  are  not  infrequently  infested,  notwithstanding  the  integu- 
ment is  thick  in  these  parts.     In  a  vast  majority  of  cases  showing  the 


'?28 


BKIN  DISEASES, 


/ -, 


discrete  or  separate  eruption  on  the  palms  and  soles  it  is  due  to  either 
scabies  or  syphilis,  and  the  presence  of  itching  in  the  former  and  its 
absence  in  the  latter  of  these  two  diseases  enables  us  to  distinguish  them 
with  great  certainty. 

2,   The  accompanying  eruptions  of  scabies  vary  somewhat  in  their 
character  according  to  situation.     Thus  the  prurigo  of  itch  is  generally 
best  defined  upon  the  forearms,  the  lower  part  of  the  abdomen,  and  the 
upper  and  inner  portion  of  the  thighs.     A  vesicular  eruption  is  more  fre- 
quent about  the  fingers  and  breasts 
of  thin-skinned  people,  and  pustules 
are  met  with  in  children  especially 
on  the  hands,  feet  and  hips. 

3.  In  searching  for  a  specimen 
of  the  insect,  which  can  be  seen 
quite  distinctly  with  a  good  mag- 
nifj'ing  glass,  it  is  well  to  look  for 
one  of  the  pimples,  which  has,  ex- 
tending from  it,  a  little  whitish  line 
about  an  eighth  of  an  inch  long  and 
generally  somewhat  curved.  This  is 
the  burrow  of  the  female  insect,  in 
which  she  has  laid  her  eggs  and  is 
raising  a  happy  little  family  to  fol- 
low her  example  and  live  off  the  fat 
of  the  land  they  inhabit.  If  the  top 
g  of  the  burrow  is  scratched  through 
very  carefully  at  its  outer  end  with 
the  point  of  a  fine  needle,  and  then  the  tiny  round  dot  which  may  be  found 
there  picked  out  on  the  needle  and  transferred  to  a  slip  of  glass,  positive 
evidence  of  the  nature  of  the  disease  can  be  at  once  detected  by  suitable 
examination  under  a  microscopic  or  hand-magnifier. 

Illustration. — The  adjoining  figure  represents  one  of  these  burrows 
of  the  acarus  scabies  or  itch  insect,  and  in  it  is  seen  the  mother  of  the 
family  at  the  upper  extremity,  whilst  eggs  and  young  in  various  stages  of 
development  are  depicted  in  different  portions  of  the  gallary  excavated 
for  their  accommodation  in  the  epidermis  of  their  hospitable  host. 

Treatment. — The  treatment  of  scabies  should  be  by  applications  which, 
whilst  they  tend  to  kill  the  insects,  will  increase  as  little  as  possible  the 
irritation  of  the  skin.     If  this  irritation  is  not  already  too  great,  the 


The  Itch  Insect  JIagnified  Two  Hundred  Times. 


LtOE. 


Y29 


patient  should  go  into  a  warm  bath  and  scrub  himself  with  brown  or  soft 
soap  for  half  an  hour;  he  should  then  lie  in  the  bath  for  another  half  hour, 
and  after  being  thoroughly  dried,  rub  himself  with  the  compound  sulphur 
ointment  all  over,  except  the  head,  for  twenty  minutes,  allowing  the  oint- 
ment to  remain  on  the  body  all  night.  This  whole  process  should  be  re- 
peated every  night  for  three  times,  which  will  probably  end  the  lives  of 

the  itch  insects  and  so  terminate  the 
malady. 

Disinfection. — In  order,  however, 
to  avoid  being  reinfected  from  the 
clothing  upon  which  some  of  the  acari 
or  their  eggs  r.iay  remain,  every  article 
that  will  bear  washing  should  be  thor- 
oughly boiled,  and  those  pieces  of  ap- 
parel which  would  bj  injured  by  Avater 
should  be  several  times  pressed  with  a 
hot  iron,  so  as  to  completely  destroy 
the  parasites. 

Further  Treatment. — When  the 
skin  is  very  irritable  the  application 
of  Peruvian  balsam  or  the  styrax  oint- 
ment should  be  tried  at  first,  and  it 
ought  to  be  remembered  that  even  in 
ihose  whose  skins  are  not  remarkably 
fender  the  sulphur  ointment,  if  used 
\cry  vigorously,  is  apt  to  prodncc  an 
eczematous  eruption,  which,  however, 
quickly  subsides  on  the  cessation  of 
the  application. 


The   Burrow    of    the    Itcll    Insect. 


IICE. 

Treatment  for  lice — The  three  kinds  of  pediculi  or  lice  which  infest 
the  head,  the  body  and  the  jaibcs  of  num,  differ  in  their  appearance  under 
the  microscope,  being  apparently  each  best  fitted  for  the  special  part  it 
has  to  play  in  tormenting  the  human  family.  They  can  all  be  defeated 
in  this  great  business  of  their  lives  by  strict  attention  to  cleanliness,  fre- 
quent bathing,  and  the  application  of  mercurial  ointment  diluted  with  five 
times  its  bulk  of  lard.     For  the  purpose  of  avoiding  salivation,  this  oint- 


VSO  BKIN  DISEASES. 

ment  should  not  be  used  directly  after  a  bath,  nor  rubbed  in  very  strongly, 
nor,  in  fact,  allowed  to  remain  in  coufact  witli  the  skin  any  more  than 
necessary,  or  a  one  to  one  thousand  solution  of  bichloride  of  mercury  may 
be  applied. 


PART  XII  OF  BOOK  IV 

Tells  of  the  bones  and  muscles  of  the  human  body 
and  the  diseases  to  which  they  are  subject. 


Abdominal  Muscle  7S2 

Abscess  within  a  Joint   742 

Ankle-to-Knee    Bones    lyj 

Arm   Bones    735 

Leverage  of   744 

Atrophy  of  the  Muscles   746 

Attachment,  Muscular   743 

Bones    ^zz 

Ankle    Ti7 

Arm    735 

Brittleness    740 

Chest   739 

Chicken    734 

Chondroma     740 

Diseases  of  the   733,740 

Dislocation  of   739 

Face    738 

Inflammatory  Affections   740 

Knee    Ti7 

Leg   72,7 

Marrow  of  the    734 

May  be  United  733 

Necrosis   740 

Nodes    740 

Number  of  733 

Osteoma  740 

Osteomalacia   740 

Osteomata    741 

Softening  of 740 

Synovitis    741 

Skull   , 7i7 

Spine    738 

Structure  of , 734 

Thorax  739 

Wrist    735 

Brittleness  of  Bone  740 

Canals.  Telescopic  View  of  tlie 734 

Chest   Bones    739 

Muscles   752 

Chicken  Bones    734 

Chondroma   740 

731 


Coxalgia   742 

Detecting  Trichina   751 

Discovery   of  Trichinae    749 

Diseases  of  the  Bones   733 ,  740 

of  the  Muscles  7^1,  746 

Dislocation  of  Bones   739 

Epidemics  of  Trichiniasis   750 

Exhaustion  Caused  by  Trichina;  ....748 

Face  Bones   738 

Muscles 745,  752 

Flexor  Muscles    745 

Fluid,  Synovial   735 

Foot  Muscles   752 

Forearm  Muscles  752 

Formation  of  Skull  738 

Fracture,  Repair  of  739 

Fragilitis  Ossicum   740 

Hand  Muscles   752 

Head  Muscles   752 

Hip    Disease    742 

Hip  Muscles   752 

Human  Skeleton,  Parts  of  736 

Hypertrophy  of  the  Muscles 746 

Inflammatory  Diseases  of  Muscles.. 746 

Intercostal  Muscles   745 

Involuntary  Muscles  743 

Joint,  Abscess  within   742 

Joints,  Kinds  of  735 

Knee-to-Ankle  Bones  7:^7 

Leg  Bones    7},7 

Muscles    752 

Leverage  of  Arm  744 

Leverage,  Muscular   ....; 744 

Longest  Muscle   745 

Marrow  of  the  Bones  734 

Muscles     742 

Abdominal    752 

Atrophy  of  746 

Chest     752 

Degeneration  of  753 

Diseases   of  the    733,   746 


732 


INDEX  TO  PAET  XII  OF  BOOK  IV. 


Flexor    74S 

Foot     752 

Forearm    752 

Hand    752 

Head     752 

Hip    752 

Inflammatory  Diseases  of   746 

of  the   Face    745,  752 

Hypertrophy  of   746 

Intercostal    745 

Involuntary    743 

Leg    752 

Longest    745 

Neck    752 

Number   of   744 

Shoulder    752 

of    Spinal    Colum:i     745 

Thigh     752 

Voluntarj'    743 

Muscular   Attachmc;.t    743 

Leverage    744 

Muscular  Sj-ster.i    7  ;-,  752 

Composition     742 

Involuntary    743 

Mechanism    743 

Voluntary     743 

Muscular  Function    742 

Myositis     753 

Necrosis    740 

Nodes    740 

Number  of  Bones    733 

of  Muscles   744 

Neck    Muscles    752 

Ossification     753 


Osteoma     740 

Osteomalacia     740 

Osteomata     741 

Paralysis    Caused   by   Trichina    ....748 

Pott's    Disease    742 

Repair  of   Fractures    739 

Shoulder   Muscles    752 

Skull    Bones    Ty7 

Skull    Formation    738 

Softening  of  Bone    740 

Spine    Bones    738 

Spinal    Column,   Muscles   of    745 

Sprains,   Nature   of   TZ7 

Structure  of  Bones   734 

Synovial    Fluid    735 

Synovitis     741 

Thigh   Muscles    752 

Thorax  Bone   Tyj 

Trichinas    747 

Characteristic  Sign  of   748 

Discovery   of    749 

Effects   of    747 

Exhaustion   in    748 

How  they  Breed   747 

Method  of  Detection   751 

Paralysis   in    748 

Trichinae  Spiralis,  Size  of  749 

Vitality   of    730 

Trichiniasis     746 

Epidemics    of    750 

Tumors    753 

Vitality  of  Trichinae  750 

Voluntary  Muscles   743 

iWrist  Bones   ,. 735 


ILLUSTRATIONS 


Bones  of  Forearm  Acting  as 

Levers   744 

Calcified    Trichin»    751 

Encysted    Trichina    747 

Human  Skeleton,  Parts  of  736 


Muscular   System    752 

Trichina   Cyst    749 

Trichina  and  Its  Cyst   7So 

Trichina  Spiralis  in  Human 

Muscles     746 


CURATIVE    MEDICINE 


PAUT  XII. 
DISEASES  OF  THE  BONES  AND  MUSCLES 

Bones.- — The  skeleton  is  tlie  framework  of  the  hody,  and  is  composed 
of  an  articulated  assemblage  of  hard  organs,  the  bones. 

It  serves  to  preserve  the  shape  of  the  body;  forms  cases  for  the  pro- 
tection of  the  vital  organs,  and  gives  attachment  to  muscles  and  forms 
levers  of  movement. 

Number  of  Bones. — The  number  of  distinct  pieces  or  bones  compos- 
ing the  skeleton  varies  at  different  periods  of  life.  Some  remain  distinct 
from  the  first  moment  of  their  development,  such  generally  being  of  the 
simplest  form,  such  as  the  bones  of  the  carpus  or  wrist,  and  the  patella  or 
knee  cap.  Others,  which  are  viewed  as  single  bones  in  the  adult,  not  only 
consist  of  several  pieces  in  the  beginning,,  but  in  the  progress  of  develop- 
ment have  other  pieces  successively  added,  as  in  the  case  of  the  vertebrsB 
or  bones  of  the  spine  and  the  thigh  bones. 

May  Unite  Bones — Again  bones  considered  as  distinct  pieces  when  the 
body  has  arrived  at  maturity,  at  a  later  period  may  become  united  with 
those  which  are  contiguous,  as  in  the  coossification  of  the  cranial  bones. 
Therefore  in  the  adult  skeleton  the  number  of  bones  to  which  we  usually 
refer  are  two  hundred  and  six,  exclusive  of  the  teeth  and  sesamoid  and 
wormian  bones,  which  are  not  imiform  in  number.  Of  this  number 
twenty-six  are  found  in  the  backbone  or  spine;  twenty-two  in  the  skull 
and  face ;  the  ribs  count  twenty-four,  twelve  on  each  side,  whether  the  per- 
son be  man  or  woman ;  each  arm  has  thirty-two  bones,  and  each  leg  has 
thirty.  These  bones  vary  very  much  in  size,  shape  and  thickness,  and  all 
have  been  named  and  described  with  great  minuteness  by  anatomists. 

Composition  of  Bones The  bones  under  every  modification  of  shapo 

and  mechanical  arrangement  are  constituted  by  precisely  the  same  elemen- 

CTSS) 


734]  DISEASES  OF  TUB  BONES  A^'l)  MUSCLES. 

tary  matters,  the  principles  of  wliicH  are  an  animal  auJ  an  earthy  suh- 
stance,  in  intimate  combination. 

Phosphate  of  lime  is  the  most  abundant  mineral  material,  being  about 
51  parts  in  the  100  of  bone.  Carbonate  of  lime,  11.3  parts ;  fluoride  of 
calcium,  2  parts. 

The  animal  matter  of  bone  is  gelatinous,  allied  to  cartilage ;  originally 
every  bone  is  developed  from  cartilage  by  ossification. 

The  mineral  matter  of  bone  increases  with  age ;  making  bones  of 
the  old  more  brittle.  There  is  more  of  it  also  in  some  bones  and  parts  of 
bones  than  in  others. 

Structure  of  Bone — A  good  idea  of  the  structure  of  a  bone  may  be 
gained  by  picking  the  second  joint  of  a  chicken  or  turkey  clean,  and  then 
sawing  off  about  an  inch  of  the  upper  end  and  splitting  this  piece  in  half 
lengthwise  Avith  a  hatchet  or  strong  knife.  This  thigh-bone  of  a  turkey 
corresponds  to  the  femur  or  thigh-bone  in  a  human  being,  where  it  lies 
near  the  centre  of  the  leg  and  reaches  from  the  hip  to  the  knee.  Ita 
upper  end  may  be  recognized  by  its  having  upon  it  a  single  round  knob, 
which  formed  part  of  the  hip-joint. 

Marrow  of  the  Bone. — On  examining  such  a  bone  it  is  found  to  be  hol- 
low in  the  middle,  and  partly  filled  with  a  fatty  substance  called  the 
marrow  of  bone.  In  this  marrow  run  important  little  blood-vessels,  which 
carry  the  blood  to  nourish  the  bone,  and  from  it  they  pass  and  repass  to 
minute  channels  running  lengthwise  in  its  substance,  which  are  called 
the  Haversian  canals,  after  the  name  of  the  jihysician  who  first  discovered 
them.  In  dried  bones,  and  especially  when  they  have  undergone  pro- 
longed bleaching  in  the  open  air,  such  as  those  of  a  long  dead  horse  or 
cow,  these  Haversian  canals  may  be  readily  seen,  looking  like  fine  pores 
in  the  broken  ends  of  the  bones. 

Telescopic  View  of  the  Canals — Under  the  microscope  they  are  dis- 
covered to  be  encircled  with  rings  of  lacuna,  or  little  holes  in  the  bone  sub- 
stance, each  of  which  communicates  with  its  neighbors  by  very  minute 
branching  tubes.  During  the  life  of  an  animal  the  lacuna  are  filled  with 
soft,  jelly-like  bone-corpuscles,  but  in  dried  bones  these  gelatinous  bodies 
shrivel  up,  leaving  the  lacuna  empty,  except  of  air,  which,  by  refracting 
light  differently  from  what  the  solid  bone  does,  makes  the  lacuna  look  like 
black  dots  under  the  microscope. 

Bones  of  a  Chicken. — If  the  breast-bone  of  a  young  chicken  is  ex- 
amined it  will  be  found  that  its  smaller  end  is  made  up  of  the  tough,  milk- 
white  or  semi-transparent  substance  caUed  gristle  or  cartilage.     When  a 


BTEUCTUEE    Oe    BONE.  73S 

chicken  is  first  hatched  nearly  all  its  bones  are  chiefly  composed  of  carti- 
lage, and  as  it  gro'svs  older  they  gradually  become  more  and  more  ossified, 
that  is,  changed  into  bone.  But  certain  portions  of  the  body  commonly 
remain  cartilaginous  through  life,  as,  for  instance,  the  gristly  bands  which 
fasten  the  ribs  to  the  breast-bone,  and  the  rings  of  the  trachea  or  windpipe. 

Bones  of  Arm. — The  bones  of  the  arm,  counting  from  the  shoulder 
downward  as  it  hangs  at  the  side,  are  first  the  humerus  or  arm-bone,  which 
extends  to  the  elbow,  and  next  the  two  bones  of  the  fore-arm,  which  make 
up  the  part  from  the  elbow  to  the  wrist,  and  are  named  the  radius  and 
ulna.  The  latter  of  these  two  bones  projects  on  the  under  side  of  the  arm, 
and  the  radius  has:  the  hand  attached  to  it,  and  is  rolled  part  way  around 
the  ulna  every  time  the  hand  is  turned  over  from  the  position  of  prona- 
tion, or  lying  with  its  palm  downward,  to  that  of  supination  or  lying  ^ipon 
its  back.  This  is  a  very  imjjortant  movement,  and  great  care  must  be  taken 
by  the  use  of  properly  padded  splints  to  save  it,  when  the  radius  and  ulna 
of  the  fore-arm  are  fractured  by  accident,  as  very  frequently  happens. 

Bones  of  Wrist. — The  wi-ist  or  carpus  is  composed  of  eight  small 
bones,  each  with  a  hard  name  derived  from  Greek  or  Latin,  and  the  palm 
of  the  hand  is  formed  by  four  of  the  metacarpal,  a  word  meaning  beyond 
the  wrist  bones,  the  metacarpal  bone  of  the  thumb  making  the  fifth.  The 
bones  of  the  fingers  consist  of  three  rows  of  phalanges,  the  thumb  having 
two  phalanges  only. 

Besides  the  bones  mentioned,  anatomists  reckon  the  shoulder-blade,  or 
scapula,  and  the  collar-bone,  or  clavicle,  as  belonging  to  the  arm,  or.  as 
they  name  it,  the  upper  extremity. 

Kinds  of  Joints. — The  joints  of  the  ann  exemplify  the  two  chief  kinds 
of  articulation  made  use  of  in  the  human  body,  namely,  the  ball  and 
socket  joint,  of  which  the  shoulder  is  an  example,  and  the  hinge-like  joint, 
of  which  the  elbow  is  a  good  illustration.  The  joints  between  the  meta- 
carpal bones  and  the  first  row  of  the  phalanges  of  the  fingers,  that  is,  those 
at  the  roots  of  the  fingers,  are  imperfectly  formed  ball  and  socket  joints, 
and  allow,  as  anyone  can  see  in  his  own  hands,  of  a  good  deal  of  lateral  or 
sidewise,  as  well  as  backward  and  forward  motion.  The  other  articula- 
tions of  the  fingers  are  hinge-joints,  and  like  the  hinges  of  a  gate,  permit 
only  of  a  back  and  forth  motion. 

The  Synovial  Fluid The  ends  of  bones  where  they  rub  against  each 

other  inside  the  joints  are  covered  with  firm  smooth  cartilage,  and  tO 
diminish  the  friction  as  much  as  possible  these  polished  surfaces  of 
cartilage  are  kept  slippery  by  a  peculiar  liquid  named  the  synovial  fluid 


736  DTRKASKS  Ol.'    1  UK  BONES   AND  MUSCI-ES. 


PARTS  OF  THE  HUMAN  SKELETON. 

Top  Central  Plate. — This  shows  the  bones  of  the  cranium,  or  head,  - 
eight  in   number.      The  large   frontal  bone   forms   the   forehead       The 
articulation  of  the  teeth  are  prominent.     It  also  shows  the  facial  bones, 
or  those  of  the  face,  fourteen  in  number. 

Middle  Central  Plate. — This  shows  the  bones  of  the  chest ;  the  sternum, 
or  breast  bone,  in  the  centre ;  the  ten  true  and  two  floating  ribs  on  either 
side,  and  part  of  tlie  backbone,  to  which  the  ribs  are  attached. 

lower  Central  Plate. — This  plate  shows  the  bones  of  the  pelvis.  Pelvis 
means  basin.  It  is  the  basin  or  girdle  by  which  the  bones  of  the  lower 
body,  as  the  hip  bones,  are  joined  to  the  upper.  The  two  large  side  bones 
are  the  os  inuominata,  or  unnamed  bones.  The  central  triangular  bone  i3 
the  sacrum,  a  composite  bone,  forming  the  union  between  the  vertebraa 
and  OS  coccyx,  or  tail  end  of  the  backbone. 

Tipper  Left-Hand  Plate — This  represents  the  eight  bones  of  the  carpus 
(wrist)  ;  the  five  of  the  metacarpus  (between  wrist  and  phalanges),  and 
fourteen  bones  of  tlie  phalanges  (battle  rank  bones),  twenty-seven  in  all. 

Next  Figure  Below. — This  is  the  sacrum,  detached  from  the  pelvic 
girdle.  It  is  also  seen  in  lower  middle  plate.  It  is  called  sacrum  (sacred), 
because  it  was  of  old  offered  up  in  sacrifices. 

Third  Left-Hand  Figure. — This  is  a  section,  or  single  joint  of  the 
backbone,   or  spinal  cord. 

Bottom  Left-Hand  Plate. — This  represents  the  femur,  or  great  thigh 
bone.  It  is  cylinder-shaped,  and  the  largest,  longest  and  strongest  bone 
in  the  body. 

Upper  Right-Hand  Plate. — This  represents  the  bones  of  the  foot. 
They  are  divided  into  three  classes.  1.  Tarsus,  or  ankle  bones,  seven  in 
all.  2.  Metatarsus  (between  tarsus  and  phalanges),  five  in  all.  3. 
Phalanges  (battle-rank  bones),  fourteen  in  all,  a  total  of  twenty-six  foot 
bones. 

Middle  Right-Hand  Plate — This  represents  a  part  of  the  backbone  or 
spinal  column.  It  consists  of  a  series  of  vertebrae,  within  which  is  the 
spinal  cord  oj-  nerve,  to  injure  whieli  means  paralysis  or  death. 

Lower  Right-Hand  Plate. — This  is  the  humerus  (shoulder),  or  bone  of 
the  upper  arm.  It  is  the  only  bone  in  the  upper  arm,  and  it  revolves  on 
the  scapula  (shoulder-blade)  above,  and  the  ulna  and  radius  of  the  fore- 
arm below. 


Parts  oft/ie  //uman  SAe/eton. 


cop,«K„r  i»,6  i>vt.j.srA.-iu;r 


or  "joint-water."  This  sjnovial  fluid,  called  also  tke  synovia,  acts  the 
part  of  oil  to  a  door  hinge,  and  when  sometimes  in  old  people  the  synovia 
becomes  scanty,  their  joints  will  creak  and  grow  stiff,  just  as  the  hinges 
of  a  door  do  for  want  of  oil.  The  ends  of  the  bones  in  a  joint  are  held 
in  place  by  a  tough,  firm  wrapper,  called  the  capsular  ligament,  which 
encloses  them  tightly  on  all  sides,  and  also  prevents  the  synovia  from 
escaping  and  being  lost. 

Bones  of  Leg. — In  general  arrangement  the  bones  of  the  legs  are  very 
similar  to  those  of  the  arms,  making  allowance  for  the  difference  in  func- 
tion of  the  two  pairs  of  limbs.  The  thigh-bone  or  femur  is  the  longest 
and  strongest  bone  in  the  body,  as  might  be  expected  from  the  larger 
share  of  work  in  walking,  running  and  leaping  it  has  to  perform.  It  is 
articulated  (or  jointed)  to  the  pelvis  at  the  lower  corner  of  the  body  by 
the  hip-joint,  a  ball  and  socket  articulation,  which  allows  of  considerable 
movement  in  every  direction. 

Knee  to  Ankle. — From  the  knee  to  the  ankle,  the  leg,  like  the  fore- 
arm, is  furnished  with  two  bones.  One  of  these,  called  the  tibia,  is  the 
ehin-bone,  forming  the  front  of  the  leg  and  the  inner  side  of  the  ankle, 
that  is,  the  side  next  the  other  limb.  The  bone  on  the  outer  side  of 
each  leg  and  each  ankle  is  named  the  fibula,  and  is  much  smaller  than 
the  tibia,  its  partner  in  the  business  of  supporting  the  weight  of  the 
body.  The  ankle  or  tarsus  is  composed  of  seven  bones  instead  of  eight, 
as  are  found  in  the  carpus,  and  it  is  articulated  below  and  in  front,  near 
the  middle  of  the  foot,  with  five  metatarsal  bones.  At  the  front,  ends 
of  the  metatarsal  bones  are  jointed  on  the  toes,  each  with  its  three  rows 
of  phalanges,  except  the  great  toe,  which,  like  the  thumb,  has  but  bxo. 

Nature  of  Sprains — The  ankle-joint  is  more  apt  to  be  "sprained"  or 
"strained,"  than  any  other,  and  this  accident,  therefore,  requires  a  fev.- 
words  of  explanation  here.  A  strain  of  a  joint  is'  the  result  of  moving 
the  bones  which  compose  it  too  far,  or  in  an  imnatural  direction,  so  that 
the  capsular  and  other  ligaments  are  stretched  or  perhaps  torn  a  little 
by  the  force  applied.  A  strained  joint  is  very  painful,  apt  to  swell 
rapidly,  and  often  proves  troiiblesome  for  months,  or  even  years,  if  not 
properly  treated.  Until  a  doctor  comes,  the  injured  articulation  should 
be  placed  in  an  elevated  position,  so  that  the  blood  will  drain  away  from 
it,  kept  perfectly  quiet,  and  covered  with  cloths  wrung  out  of  hot  or  cold 
water,  so  as  to  reduce  the  danger  of  inflammation. 

Bones  of  Skull. — The  bones  of  the  skull  or  cranium  are  broad,  com- 
paratively thin,  and  curved  in  such  a  way  as  to  make  a  hollow  casa  or 
Ml 


738  DISEASES  OF  TIIK  KONKS  AND  MUSCLES. 

oval  box,  shaped  a  good  deal  like  an  egg,  for  the  i)roteetion  of  the  brain, 
which  is  placed  inside  of  them.  Tlie  most  important  are  the  frontal  or 
forehead  bone,  the  two  temporal  or  temple  bones  and  the  occipital  bone, 
which  is  at  the  back  of  the  head.  These  bones  are  united  together  by 
seams  or  sutures,  consisting  of  a  curious  kind  of  dove-tailing,  which  fas- 
tens them  so  firmly  together  that,  in  their  natural  state,  it  is  impossible 
to  get  them  apart  -without  breaking  them. 

Character  of  Skull  Formation — The  arch  form  of  the  skaW  makes 
it  much  more  capable  of  resisting  blows  upon  the  head ;  but  if  these  are 
so  severe  as  to  fracture  the  bones,  especially  if  they  are  dented  in  so  as 
to  press  upon  the  brains,  unconsciousness  is  often  very  quickly  produced. 
Tliis  would  hajipen  miich  more  frequently  were  it  not  for  the  layer  of 
spongy  matter  interposed  between  the  hard  plates  which  form  the  cranial 
bones. 

Bones  of  the  Face. — The  bones  of  the  face  are  comparatively  light 
and  thin,  except  the  lower  jawbone,  into  which  are  set  the  lower  teeth, 
and  which  is  the  only  bone  about  the  head  which  is  furnished  with  a 
movable  joint,  except  the  occipital  bone,  where  it  rests  upon  the  neck. 

Bone  of  Spine — The  spine  or  backbone  is  made  up  of  twenty-four 
vertebra;,  the  sacrum  and  the  coccyx.  These  latter  bones  seem  to  be  each 
composed  of  several  vertebra;,  which,  for  the  purpose  of  being  rendered 
stronger,  have  growTi  fast  together.  The  uppermost  vertebrte  is  called 
the  atlas,  because  upon  it  the  head  is  supported ;  and  the  second  is  named 
the  axis,  because  upon  it  the  atlas,  and  with  it  the  whole  head,  turns,  as 
in  shaking  the  head  negatively.  The  upper  seven  vertebras  are  called 
the  cervical  or  neck  bones;  the  next  twelve  are  designated  as  the  dorsal 
or  back  vertebr£e;  and  the  last  five  are  named  the  lumbar  vertebrte  or 
vertebrae  of  the  loins.  These  twenty-four  bones  are  fitted  together  in  such 
a  way  as  to  form  a  continuous  tube,  which  receives  and  protects  the  spinal 
cord  or  spinal  marrow  just  as  the  upper  continuation  o-f  the  spinal  cord — 
that  is,  the  brain — is  encased  and  protected  by  the  bones  of  the  skull. 
The  vertebrae  are  jointed  so  as  to  allow  considerable  motion,  both  sideways, 
forward  and  backward,  and  have  between  each  pair  a  cushion  of  fibro- 
cartilage,  which  serves  to  preserve  the  brain  from  injury  by  the  shocks 
and  jars  which  would  otherwise  be  given  to  it  in  jumping,  running  and 
various  other  movements.  The  sacrum,  which  is  continuous  vrith  the 
vertebrae,  is  united  with  two  large,  flat  and  irregularly-shaped  bones,  to 
form  the  pelvis  or  basin  at  the  lower  part  of  the  trunk.  The  pelvis  sup- 
ports the  spine  and  the  organs  in  the  abdominal  cavity,  and  is  in  its  turn 


OIBLOCATION  OF  BONE8.  739 

sustained  on  each  side  by  the  thigh  bones,  which  prop  it  np  at  the  hip- 
joints,  as  already  indicated. 

Bones  of  the  Thorax  or  Chest — The  heart  and  hmgs  are  protected 
by  a  bony  cage  composed  of  the  twenty-four  ribs,  which  lie  a  little  be- 
neath the  skin  of  the  thorax  or  chest  and  in  thin  persons  can  be  easily  felt 
at  the  sides  or  near  the  breast-bone.  This  breast-bone  or  sternum  is  sit- 
uated directly  in  the  middle  or  front  of  the  thorax  and  has  the  front  ends 
of  the  ribs  attached  to  it  by  cartilages,  named  the  costal  or  rib-cartilages, 
which  allow  of  the  outward  and  upward  movement  of  the  ribs,  necessary 
in  breathing. 

The  back  or  posterior  ends  of  the  ribs  arc  jointed  on  to  the  verte- 
brae of  4he  spinal  coluum  in  such  a  way  as  to  allow  of  needful  motion, 
and  yet  secure  sufiieicnt  stability  and  firmness. 

Dislocation  of  Bones — ^When  a  dislocation  occurs,  or,  as  it  is  com- 
monly called,  a  bone  is  put  out  of  joint,  the  bones  composing  an  articu- 
lation have  been  pulled  or  twisted  so  hard  as  to  displace  thom,  breaking 
some  of  the  ligaments  Avhich  are  arranged  to  keep  them  in  their  proper 
positions. 

Example  of  Dislocation. — Generally,  a  person  whose  arm,  at  the 
Bhoulder,  for  example,  is  dislocated,  suffers  a  good  deal  of  pain  and  loses 
the  use  of  the  limb  until  the  bones  are  put  back  in  their  places  again, 
or  as  it  is  called,  the  dislocation  is  reduced. 

A  dislocation  is  one  of  the  heavy  penalties  people  often  have  to  pay 
for  imprudent  over-exertion  in  lifting  and  wrestling,  or  for  carelessly 
letting  themselves  have  falls  and  hard  knocks,  or  becoming  entangled  in 
railway  accidents. 

Bepair  of  Fractures — The  repair  of  broken  or  fractured  bones  is  a 
wonderful  process  of  nature,  in  which  a  material  called  callus,  at  first  like 
putty,  is  formed  aroimd  the  broken  ends,  holding  them  together,  feebly 
at  first,  but  afterward  it  gradually  hardens,  imiting  them  more  firmly 
indeed. 

Since  this  "knitting"  of  the  broken  bones  may  occur  in  almost  any 
position  they  happen  to  lie  in,  or  are  pulled  into  by  the  irritated  muscles 
in  the  neighborhood,  it  is  evidently  very  important  that  they  should  bo 
put  and  kept  in  exactly  the  right  place.  For  this  purpose  there  are  many 
ingenious  splints  and  bandages  devised  and  used  by  surgeons.  See  Acci- 
dents and  Emergencies  and  Surgical  Diseases. 


'740  DISEASES    or    THE    BONES    AND    MUSOLES. 


DISEASES  OF  THE  BONE. 

Inflammatory  Affections. — These  sometimes  follow  woiinds^  but  are 
more  common  as  result  of  syphilitic  or  scrofulous  disease.  There  is  swell- 
ing and  pain  of  affected  part  (especially  at  night).  Unless  overcome  in 
early  stage,  necrosis  is  apt  to  follow. 

Necrosis — This  disease  is  akin  to  mortification  of  the  flesh  and  is 
sometimes  called  Death  of  the  Bones.  It  may  occur  from  injuries  to  and 
inflammation  of  the  periosteum  or  may  be  due  to  phosphorous  poisoning. 
There  is  dull,  deep-seated — sometimes  acute — pain,  followed  by  increase 
of  size  and  the  formation  of  new  bone  aroimd  the  old.  There  is  tenderness 
and  distension  and  a  breaking  down  of  tissue  with  a  discharge  of  pus 
and  of  small  particles  of  bones.  Blood  poisoning  frequently  ensues  from 
absorption  of  dead  bone  tissue  that  has  not  found  outlet.  To  prevent  this 
an  incision  should  be  made  over  a  swelling  in  bone  troubles  if  pus  be  sus- 
pected and  thus  permit  escape  of  diseased  parts.  This  should  only  bo 
done  by  a  skilled  surgeon  and  under  thorough  antiseptic  conditions.  Tem- 
porary relief  is  obtainable  by  poultices  and  quieting  fomentations.  Surg- 
ery is  usually  necessary,  all  diseased  bone  being  scraped  away. 

Nodes. — These  are  hard,  bony  swellings,  which  are  apt  to  occur  as 
tertiary  symptoms  of  constitutional  syphilis.  They  are  most  common  in 
long  bones  and  are  frequently  found  on  the  front  surface  of  shin-bone. 
They  are  often  painful  for  a  time,  particularly  at  night,  but  yield  promptly 
to  treatment  with  the  iodide  of  potassium  in  the  majority  of  cases. 

Softening  of  Bone  (Osteomalacia) — This  is  an  uncommon  disease  ob- 
served in  adults ;  seldom  seen  in  males,  occurring  in  greater  frequency  in. 
females.  It  is  characterized  by  a  softening  of  the  bones,  rendering  them 
very  liable  to  break  or  bend  on  the  application  of  little  force;  resulting 
from  absorption  or  deficiency  of  the  earthy  matters  in  the  bones. 

Brittleness  of  Bone  (Fragilitis  Ossicnm)  — This  is  an  affection  of  bone 
in  which  the  inorganic  are  out  of  projiortion  to  the  organic  constituents, 
rendering  the  bones  brittle;  there  is  an  apparent  increase  of  the  earthy 
matters,  with  a  diminution  of  the  vascularity  of  the  bone.  Children  and 
young  persons  seem  to  suffer  most  from  this  disease,  and  in  many  instances 
an  hereditary  tendency  can  be  traced. 

Osteoma  (Chondroma). — The  bones  are  subject  to  tumors,  to  cartila- 
ginous or  other  growths.  They  form  hard  rounded  tumors,  fixed  to  their 
point  of  origin.     They  may  attain  a  huge  size — but  are  usually  smalL 


WSEASKS  OF  BOIHBS.  741 

They  grow  slowly  without  pain  or  other  symptoms  except  such  as'  may  be 
caused  by  their  bulk  or  pressure,  and  interfere  with  the  functions  of 
neighboring  nerves. 

Osteomata  are  liable  to  inflammation  and  necrosis,  but  never  under- 
go malignant  or  cancerous  degeneration.  Chondromata  may  not  only 
become  inflamed,  and  necrosis  and  sloughing  follow;  but  it  becomes  can- 
cerous in  some  instances ;  for  instance,  after  an  injury  to  a  bone,  a  chon- 
droma may  appear  and  develop  with  terrible  rapidity,  and  upon  its  re- 
moval may  return,  become  cancerous  and  form  secondary  tumors  else- 
where. 

Treatment. — If  osteomata  or  chondromata  are  removed  whilst  small 
the  operation  is  to  be  recommended,  but  when  left  imtil  a  huge  tumor 
has  developed,  of  the  nature  of  which  no  doubt  can  be  entertained,  any 
interference  is  of  questionable  propriety. 

Synovitis. — Among  the  important  diseases  of  the  joints  must  be  men- 
tioned synovitis  or  inflammation  of  the  lining  membrane,  by  which  the 
synovia  or  joint-water  is  secreted.  This  disease,  usually  attended  with 
severe  pain,  and  when  the  joint  is  a  large  one  accompanied  with  much 
constitutional  disturbance  and  fever,  appears  in  two  forms,  the  acute  and 
the  chronic. 

Causes — The  acute  form  is  usually  the  result  of  injury,  which  may 
be  very  slight  in  its  character,  as  even  the  least  puncture  of  the  joint 
by  which  air  can  enter  is  liable  to  produce  it.  Acute  synovitis  rims  its 
course  in  ten  or  twelve  days,  causing  much  swelling  and  severe  suffering 
on  the  slightest  movement  of  the  limb  to  which  the  joint  is  attached.  The 
chronic  form  is  commonly  a  continuation  of  the  acute,  and  may  itself 
result  in  softening  and  what  is  called  pulpy  degeneration  of  the  synovial 
membrane. 

Treatment — The  treatment  of  synovitis  is  by  free  leeching  of  the 
affected  part;  perfect  rest  in  bed,  with  the  limb  elevated  and  secured  in 
a  splint  if  needful ;  low  diet  with  saline  purgatives,  such  as  epsom  salts 
or  seidlitz  powders,  and  anodynes  to  relieve  pain.  In  the  chronic  form 
small  blisters  and  painting  with  tincture  of  iodine  are  likely  to  prove 
useful.  Inflammation  of  the  synovial  structure  of  the  joints  is  apt  to  take 
on  a  rheumatic,  scrofulous  or  syphilitic  character  in  persons  who  are  con- 
stitutionally under  the  influence  of  these  taints.  In  such  instances  the 
appropriate  treatment  for  them,  as  already  pointed  out,  is  to  be  associated 
with  that  for  ordinary  synovitis. 

Ulceration  of  the  cartilages  may  occur  in  a  joint  as  a  consequence  «f 


T42  UTSEASES  OF  THE  BONES  ANT>  MUSCLES. 

long-continued  inflammation,  causing  intense  pain,  nml  nsnally  disabling 
the  limb.  Its  liability  to  occur  renders  the  prompt  treatment  of  synovitis 
doubly  important. 

Abscess  (Coxalgia). — Abscess  within  a  joint  is  rare  in  healthy  per- 
sons, bwt  in  the  scrofulous  it  is  by  no  means  uncommon,  and  in  strumous 
children  abscess  in  the  hip-joint,  causing  the  lamentably  frequent  affec- 
tion, coxalgia,  is  a  malady  of  much  importance. 

Treatment — The  general  treatment  in  these  sad  cases  is  that  already 
indicated  for  scrofula,  but  the  local  trouble  should  be  immediately  at- 
tended to  by  an  exjiericnced  surgeon,  and  remedied  as  far  as  possible  by; 
the  aid  of  the  complicated  apparatus  devised  for  the  purpose. 

Pott's  Disease. — This  consists  of  a  tubercular  inflammation  of  the 
bodies  of  the  vertebrae  or  spinal  bones,  and  their  cartilages ;  and  is  most 
common  in  children  between  two  and  ten  years  of  age,  altho\igh  it  may 
occur  at  any  age.  In  some  cases  the  affection  appears  to  follow  a  slight 
injury  to  the  spine  in  those  of  tubercular  or  strumous  tendencies,  in  others 
the  disease  develops  without  apparent  exciting  causes. 

Symptoms — Rigidity  of  spine,  tenderness  and  local  pain  are  the 
prominent  early  symptoms.  Abscess  may  occur  early,  but  is  most  com- 
mon in  the  late  stages.  Deformity  or  spinal  curvature  nsually  occurs  as 
a  result  of  the  disease  process,  depending  upon  the  an^ount  of  breaking 
down  in  the  bones  and  the  falling  together  of  the  vertebra?,  and  may  be 
gradual  or  rapid  in  its  development.  Treatment  is  as  indicated  in  article 
on  Coxalgia. 

THE  MUSCTJIAH  SYSTEM. 

Muscular  Function. — The  power  which  moves  different  parts  of  the 
frame,  according  to  the  directions  of  the  will,  as,  for  instance,  the  legs,  in 
walking,  is  produced  by  the  contraction  of  muscles.  These  muscles  form 
the  lean  meat  of  animals  and  of  the  human  body,  and,  except  in  very  fat 
people,  make  wp  a  larger  portion  of  the  bulk  of  the  frame  than  any  of  its 
other  constituents. 

Composition — They  are  composed,  as  is  readily  seen  in  a  piece  of 
fresh  beef  or  mutton,  of  long  strings  of  reddish  material,  which,  imder  the 
microscope,  are  found  to  be  made  up  of  a  multitude  of  fine,  beaded 
threads,  arranged  in  small  bundles,  and  called  the  ultimate  muscular 
fibres.  They  exercise  power  in  moving  the  limbs,  and  so  forth,  by  shorten- 
ing up  or  contracting  when  excited  by  the  nervous  fluid,  sent  to  them 
through  the  nerves  from  the  brain,  as  ordered  to  do  so  by  the  will. 


THE  MTrSOTri.AB  BYSTKlf.  743 

Mechanism — The  exact  mechanism  of  moving  the  arm,  for  instance, 
by  the  process  of  contraction,  may  he  easily  imderstood  from  the  picture 
shown  on  page  752,  in  wHich  it  is  readily  perceived  that  the  shortening  up 
of  the  muscle  must  pull  up  the  hand,  bending  the  arm  at  the  elbow-joint, 
and  changing  the  position  from  that  represented  in  the  second,  to  that 
shown  in  the  third  figure.  Precisely  the  same  kind  of  operations  accom- 
plish the  motions  of  lifting  the  feet  in  walking  or  climbing,  swinging  the 
arm  in  throwing  a  ball,  ojiening  and  shutting  the  mouth,  and,  indeed,  of 
most  of  the  voluntary  movements  of  which  we  are  capable. 

Voluntary  and  Involuntary — But  whilst  many  of  the  muscles  are  con- 
trolled by  the  will  and  are,  therefore,  called  voluntary,  many  of  them  arc 
not  so  ruled,  and  hence  have  received  the  name  of  involuntary. 

Most  Important  Involuntary  Muscles — ^Among  the  most  important  of 
the  involuntary  muscles  are  the  heart,  the  intercostal  muscles,  the  muscles 
between  the  ribs  which  help  to  expand  the  lungs  in  respiration,  and  the 
muscular  fibres  of  the  alimentary  canal,  which  aid  in  pushing  along  the 
food  in  digestion.  Fortimate  is  it  for  us  that  such  is  the  fact ;  for  other- 
wise, when  our  wills  were  off  duty,  as  in  sound  sleep,  the  operations  of 
these  vital  organs  would  stop,  and  life,  which  depends  upon  them,  soon 
cease. 

Muscular  Attachment — The  muscles  are  usually  attached  to  the  bones, 
and  move  them  by  sinews  or  tendons,  Avhich  are  made  of  white,  fibrous 
tissue,  the  strongest  and  most  flexible  material  in  the  body.  These  ten- 
dons are  like  long,  round,  white  cords,  such  as  may  be  seen  in  the  lower 
part  of  the  leg  of  a  chicken.  The  largest  tendon  in  the  human  body  is 
that  of  the  heel,  called  the  tendon  Achilles,  which  is  the  continuation  of 
the  big  muscle  of  the  calf  of  the  leg.  This  powerful  muscle  is  used  in 
jumping  and,  since  it  acts  at  a  great  disadvantage,  is  necessarily  very 
strong  in  order  to  be  able  to  throw  the  entire  body  forward,  as  in  making 
a  leap. 

Origin  and  Insertion. — As  a  general,  but  by  no  means  imiversal,  rule, 
a  muscle  has  one  attacliment  which  is  fixed,  commonly  spoken  of  as  its 
origin,  and  a  second,  called  its  insertion,  upon  which  it  acts  by  drawing  it 
toward  the  origin  when  the  muscular  substance  contracts.  Muscles 
mostly  pass  in  a  straight  line  between  their  two  attachments,  but  some- 
times they  act  around  an  angle  by  sliding  over  a  pulley,  or  by  means  of 
a  small  bone  in  the  tendon,  like  the  knee-pan.  The  muscles  are  so  attached 
that  they  are  always  slightly  on  the  stretch,  and  thus,  at  the  moment  they 
begin  to  contract,  they  are  in  an  advantageous  position  to  bring  their 


ru 


D1SEA«BI  OI  TUB  BONES  AND  MU80LK8. 


action  to  bear  on  the  bones  which  they  move.  When  the  contraction 
ceases,  the  bones  are  drawn  back  to  their  former  position  without  anj 
sudden  jerk. 

Muscular  Leverage — The  muscles  commonly  act  upon  the  bones  as 
levers,  by  working  upon  the  short  arm  of  the  lever,  so  that  more  direct 
force  is  required  on  the  part  of  the  muscle  than  there  is  weight  in  the 
body  moved.  From  this  arrangement,  however,  the  indispensable  advan- 
tage is  gained  that  the  small  contraction  of  the  muscle  causes  an  extensive 
movement  of  the  part  acted  upon,  and  much  greater  rapidity  of  motion  is 
secured.  Each  of  the  three  orders  of  levers  is  met  with  in  the  different 
bones  of  the  human  skeleton;  often,  indeed,  all  three  varieties  are  found 
in  the  same  joint,  as  for  example,  the  elbow,  where  the  simple  flexion  and 
extension  of  the  biceps  and  triceps  muscles,  which  are  large,  fleshy  masses 
on  the  front  and  back  of  the  arm,  between  the  shoiilder  and  elbow,  afford 
excellent  illustrations,  as  sho\\Ti  in  the  accompanying  figure. 

Illustration  of  Leverage — The  arm  is  used  as 
a  lever  of  the  first  order  when  the  triceps  is  caused 
to  contract,  and  by  pulling  ujion  the  upper  end  of 
the  forearm  moves  the  hand  around  the  elbow- 
joint,  which  serves  as  a  fulcrum.  This  is  shown  in 
tlie  uj)per  diagram  in  which  the  hand  is  repre- 
sented as  striking  a  blow  with  a  dagger. 

Again   the   aiTU   furnishes   an   example   of  a 
lever  of  the  second  order,  when  the  hand  resting 
on  a  point  of  support,  such  as  a  table,  acts  as  the 
fulcrum,   and  the   triceps  muscle  pulling  on   the 
^  upper  end  of  the  ulna  or  smaller  arm  bone,  by 

\     '^^^^.x  straightening  the  arm  lifts  a  weight  placed  upon 

it  in  front  of  the  elbow. 

The  third  order  of  levers  is  exemplified  by 
the  arm  when  bent  by  the  contraction  of  the  bi- 
ceps in  ordinary  flexion  of  the  elbow.  Here  the 
muscle,  which  is  the  power,  is  placed  between  the 
fulcrum,  which  is  the  lower  end  of  the  humerus  at 
''"as  "ive^rt  of 7hrTifr«"''  ^^^  clbow-joiut,  and  the  weight,  which  is  lifted  in 
°"^'"'  the  pnlm  of  the  hand,  «s  shown  in  the  lower  dia- 


Number  of  Muscles.— The  whole  number  of  muscles  in  the  human 
being  is  not  far  from  five  himdred,  mostly  arranged  in  pairs  on  opposite 


TM.a  MUBODLAK  SYSTEM.  745 

sides  of  the  bead,  body  or  limbs.  It  is,  tberefore,  manifestly  impossible 
to  describe  tbem  all  in  detail  tere,  and  yet  there  are  a  few  wbich  are 
important  enough  to  require  notice. 

Important  Muscles  of  the  Face — Among  the  muscles  of  the  face  should 
be  mentioned  those  of  the  eye,  six  in  number,  four  of  which  turn  the  eye- 
ball up  or  down,  inward  toward  the  nose  or  outward  toward  the  temple,  as 
becomes  necessary  to  see  an  object  distinctly.  The  muscles  of  expression 
are  especially  attached  about  the  mouth,  and  produce  their  effects  by  puck- 
ering up  the  lips,  as  in  whistling;  drawing  wp  the  corners  and  widening 
the  mouth,  as  in  laughing ;  pulling  down  its  angles,  as  in  weeping,  and  so 
forth.  The  masseter  muscles  placed  inside  the  cheeks  between  the  upper 
and  lower  jaws  are  very  strong,  and  enable  human  beings  to  chew  up  some 
very  hard  articles  of  food  in  the  operation  of  mastication,  as  has  been 
already  explained. 

Flexor  Muscles — The  action  of  the  large  muscle  of  the  front  of  the 
arm,  called  the  bicej^s  or  two-headed  muscle,  has  been  already  described. 
The  muscle  of  the  forearm,  which  shut  the  fingers  as  in  clasjiing  the 
hand,  are  called  the  flexors,  because  they  flex  or  bend  the  fingers.  The 
tendons  by  which  their  power  is  conveyed  may  be  readily  felt  on  the  inside 
of  the  ^vrist  of  a  man  who  tries  to  shut  his  hand  when  the  fingers  are 
forcibly  held  open  by  another  person.  The  forearm  muscles  which  open 
out  the  fingers  after  the  hand  is  closed,  in  doubling  up  the  first  for  in- 
stance by  the  flexors,  are  called  the  extensors.  The  tendons  of  the  ex- 
tensor muscles,  when  the  latter  are  strongly  contracted,  show  very  dis- 
tinctly on  the  back  of  the  hand,  as  straight,  hard  cords,  running  from  the 
root  of  each  finger  to  the  middle  of  the  wrist. 

Muscles  of  the  Spinal  Column — The  spinal  column  is  almost  sur- 
rounded, except  in  front,  by  a  thick  mass  of  muscles,  which  gives  the  great 
strength  required  by  many  kinds  of  laborers,  such  as  porters  who  carry 
heavy  loads  upon  their  backs.  The  muscles  of  the  leg,  which  are  needed 
in  walking,  running  and  jumping,  are  very  large  and  strong,  correspond- 
ing to  the  hard  Avork  they  are  called  upon  to  perform. 

The  longest  Muscle. — The  longest  muscle  in  the  body  is  the  sartorius 
or  tailor's  muscle,  which  is  so  named  because  it  helps  to  bend  the  lower 
limbs  into  the  cross-legged  posture  so .  frequently  adopted  by  tailors.  It 
lies  on  the  inside  of  the  thigh,  is  thin  and  narrow,  but  sometimes  measures 
over  two  feet  in  length. 

Intercostal  Muscles. — The  intercostals  are  flat,  thin  layers  of  muscular 
fibres,  which  extend  from  the  lower  edge  of  each  rib,  except  the  last  pair, 


746 


DISEASES  OF  THE  BONES  AND  MUSCLES. 


to  the  upper  margin  of  the  rib  next  below.  In  tliis  way  they  fill  up  all  the 
spaces  between  the  bars  of  the  bony  cage  in  which  the  lungs  are  contained, 
and,  when  tliey  contract,  pull  iip  these  bars  or  ribs  so  as  to  widen  and 
deepen  the  cavity  of  the  thorax,  and  so  cause  air  to  be  drawn  into  the  lungs. 

DISEASES  OF  THE  MTJSCLES. 
Inflammatory  Disease — Inflammatory  disease  of  the  muscular  system, 
except  as  it  is  connected  with  rheumatism  or  pyemia,  is  extremely  un- 
common. When  it  occurs  it  is  liable  to  go  on  to  suppuration,  and  the  for- 
mation of  abscess.  The  pain  is  dull  and  aching  rather  than  acute,  r.nd  the 
disease  is  to  be  treated  as  already  directed  in  speaking  of  the  manage- 
ment of  boils. 

Hypertrophy  and  Atrophy. — These  occur  in  muscles  and  i>roduce  ef- 
fects important  or  otherwise,  according  to  the  jjosition  of  the  muscle  in 
the  animal  economy.  The  most  important  hyper- 
trophy is  that  of  the  muscle  composing  the  heart,  the 
influence  of  which  has  been  detailed  in  the  article  on 
valvular  disease  affecting  this  organ. 

Contractions. — Palsy  and  spasm  in  various  forms 
have  also  been  considered  in  the  chapter  on  diseases 
of  the  nervous  system,  upon  which  these  disturbances 
chiefly,  thought  not  entirely,  depend. 

Trichiniasis.- — The  most  important  disease  of  the 
muscular  system  not  yet  discussed  is  its  infection 
with  parasites,  and  particularly  with  the  trichina 
spiralis  or  pork  worm,  which,  in  consequence  of  the 
late  embargoes  upon  American  hams  and  bacon,  has 
assumed  a  national  or,  indeed,  an  international  im- 
portance. The  great  fatality  in  many  cases  of 
trichiniasis,  as  the  malady  produced  by  the  trichina 
has  been  named,  and  the  ease  with  which  the  whole 
trouble  can  be  avoided  by  a  proper  understanding  of 
the  nature  and  origin  of  the  affection,  render  a  full 
account  of  the  entire  malady  and  its  means  of  prevention  singularly 
appropriate  to  a  popular  work  like  the  present  one. 

The  Trichina  Spiralis — The  trichina  spiralis,  which  is  next,  perhaps, 
to  the  echinococcus,  the  most  dangeroiis  animal  parasite  infecting  man,  is 
found  also  in  pigs,  foxes,  giiinca-pigs,  rats,  cats,  mice,  marmots,  polecats, 
badgers,  and  more  rarely  in  some  other  animals,  including  the  dog.     A 


Trichina    Spiralis   in 
Human   Muscles. 


DISEASES  OF  THE  MUSCLES. 


747 


physician  of  Philadelphia  found  that  of  ten  cats  which  ho  dissected  in 
1879  nine  were  infested  with  trichinse. 

Sources  of  Trichinae — Pigs,  from  whicli  the  human  race  is  most  apt 
to  become  diseased  with  trichina,  are  supposed  to  become  themselves  in- 
fected, chiefly  from  eating  rats,  the  ofFal  of  other  pigs,  and  the  excreta 
of  human  beings  containing  trichinaj.  It  is  doubtful  whether  a  single  case 
of  trichiniasis  in  man  ever  occurred  where  the  patients  became  infected 
otherwise  than  by  eating  raw  or  underdone  pork,  and  the  most  common 
sources  of  infection  arc  sausages,  ham  and  bacon. 

How  Trichinae  Breed — If  the  trichinas  existing  in  diseased  pork  are 
very  yoimg  they  may  bo  simply  digested,  when  they  reach  the  human 

stomach,  without  being  developed. 
But  if  the  parasites  have  attained  their 
fuller  growth,  the  cysts  which  contain 
them  are  alone  dissolved  by  the  gastric 
juice,  and  the  erabyro  is  set  free. 
These  embryos,  after  they  pass  through 
the  pylorus  and  duodenum,  soon  be- 
come mature,  and  their  thread-like  ap- 
pearance renders  them  quite  easily 
recognizable  by  the  naked  eye.  Coimt- 
less  eggs  are  now  discharged  by  the 
females,  and  in  about  a  week's  time 
the  new  brood  of  trichina3  hatched  out 
from  these  eggs  begin  to  make  their 
way  to  the  muscles,  either  by  boring 
their  way  through  the  soft  tissues,  or 
by  being  carried  along  by  the  current 
of  blood  in  the  blood-vessels,  or  per- 
haps by  both  of  these  methods  of 
progression  through  the  body.  These 
larval  triehinaj  attain  their  full  size  in 
about  two  weeks  from  the  time  they 
leave  the  egg.  The  males  and  females 
are  each  about  one-thirtieth  of  an  inch  long  and  about  one  seven-hun- 
dredth of  an  inch  broad. 

Effects  of  Trichinae — In  some  few  favorable  cases  severe  gastro- 
intestinal inflammation  is  set  up,  and  the  parasites  are  violently  expelled 
by  diarrhoea,  without  being  able  to  enter  the  muscles  at  all,  so  that  if  it 


Encysted  Trichina   More  Highly   Magnified 
Showing   Structure   of   the    Parasites. 


748  DISKASBS  OF  THE  BOITES  AITD  MUSOLKS. 

■were  possible  to  detect  the  malady  with  certainty  at  this  stage,  nature 
thus  suggests  the  appropriate  treatment  by  drastic  purgatives.  In  the 
majority  of  instances,  however,  the  migration  of  immense  numbers  of 
larval  trichina}  from  the  intestinal  canal  takes  place,  and  occupies  in  gen- 
eral about  four  days  only.  In  this  brief  space  of  time  even  the  most  dis- 
tant muscles  of  the  body  may  all  be  invaded. 

Symptoms. — Among  the  earlier  symptoms  of  the  trichina  disease  are  a 
general  feeling  of  debility  and  discomfort,  and  a  loss  of  appetite,  to  which 
succeed  nausea  and  vomiting,  diarrhcea,  prostration  of  strength,  and  a  sen- 
sation of  stiffness  about  the  neck,  arms  and  legs.  These  evidences  of  illness 
resemble,  it  will  be  observed,  to  a  great  extent,  the  first  stage  of  typhoid 
fever,  for  which  the  cases  are  usually  mistaken  if  there  is  no  point  in  the 
history  of  the  patient  to  suggest  trichiniasis.  The  further  progress  of  the 
parasites  through  the  tissues  sets  up  high  fever,  with  frequent  pulse  and 
copious  offensive  perspirations,  although  the  temperature  of  the  body  sel- 
dom or  never  reaches  the  elevation  which  characterizes  that  of  typhoid. 
For  some  days  the  stiffness  of  the  limbs  seems  to  increase,  while  all  the 
muscles  become  painful,  swollen,  and  very  sensitive  to  the  touch. 

A  Characteristic  Sign — ^About  the  end  of  the  first  week  the  attention 
of  the  attending  physician  is  usually  awakened  (if  it  has  not  previously 
been  aroused)  to  a  suspicion  of  the  trichina  disease  by  the  appearance  of 
an  edematous  swelling  of  the  eyelids  and  root  of  the  nose.  This  is  often 
the  first  characteristic  sign  of  trichiniasis,  and  should  be  looked  for  at  this 
period  of  the  illness  in  all  cases  of  supposed  typhoid  and  rheumatic  fever. 
During  the  second  week  movement  of  the  intercostal  miiscles  in  respira- 
tion grows  very  painful,  thus  preventing  to  a  great  extent  the  necessary 
repose  of  the  patient.  If  the  diaphragm  is  invaded,  severe  hiccough  is 
apt  to  come  on,  and  when  the  larval  trichinae  commence  to  infest  the 
laryngeal  muscles  hoarseness  and  loss  of  voice  make  their  appearance. 

Cause  Paralysis  and  Exhaustion — When  a  large  quantity  of  trichinous 
meat  has  been  eaten,  so  that  the  immigration  into  the  muscles  of  the 
afflicted  patient  is  by  millions,  they  soon  cause  an  almost  paralyzed  con- 
dition, attended  by  excessive  exhaustion.  The  facial  edema  continues 
through  the  second  week,  when  it  generally  disappears,  and  is  followed  by 
swelling  of  the  feet  and  legs,  and  ultimately  of  the  trunk.  At  the  end  of 
the  third  week,  if  the  patient  suiwives  to  this  period,  the  pulse  and  respira- 
tion are  very  frequent,  the  tongue  is  red  and  dry;  the  mouth  can  scarcely 
1)0  opened,  the  sweating  is  profuse,  the  pain  so  severe  that  little  or  no  sleep 
can  be  obtained,  and  there  is  great  anxiety  or  delirium,  death. frequently 


DiaXASltiti  Vif  THK  MUSOI.BS. 


'749 


occurring  in  tie  fourth  or  fifth  week,  witL  symptoms  of  jirofound  ex- 
haustion. 

Complications — Complications,  sucli  as  pneumonia,  peritonitis  nml 
pleurisy,  are  not  uncommon,  but  in  favorable  cases  when  the  number  cf 
triehinte  is  comjDaratively  small,  or  the  constitution  of  the  patient  un- 
usually vigorous,  the  pain,  swelling  and  diarrhcea  begin  to  abate,  the  op- 
pression of  breathing  ^Jasses  off,  the  desire  for  food  returns,  sleep  is  ob- 
tained, and  the  anemic  patient  enters  upon  a  slow  and  tediou3  con- 
valescence ;  the  parasites  having  become  encysted  within  the  muscles,  these 
gradually  become  acclimated,  as  it  were,  to  the  presence  of  the  foreign 
bodies,  and  slowly  regain  most  or  all  of  their  original  powers  and 
iimctions. 

Further  Symptoms. — After  piercing  the  fibrous 
eheath  of  the  muscular  fibre  bundles,  the  embryonic 
trichluEB  become  encysted  within  lemon-shaped  capsules 
(generally  one  worm  in  each  capsule),  of  a  sort  of  con- 
nective tissue,  in  which  they  have  some  freedom  of 
movement.  After  a  time,  these  capsules,  which,  of 
course,  are  fixed  to  one  spot  in  the  muscle,  become 
calcified,  a  process  which  occupies  in  man  about  two 
years.  During  this  jieriod  there  is  often,  for  a  time,  in 
patients  who  recover,  some  loss  of  power,  for  a  while 
almost  complete,  in  muscles  or  groups  of  muscles;  but 
not  infrequently,  after  this  stage  is  reached,  entire  re- 
covery ultimately  seems  to  take  place.  Still,  this  in- 
fested condition  of  the  muscle,  which  probably  exists  in 
thousands  of  people  who  walk  about  utterly  unconscious  of  it,  may  be  the 
yet  undetermined  cause  of  rheumatism  and  paralysis,  or  promote  the 
development  of  consumjition  and  other  wasting  diseases. 

Size  of  Mature  Trichinae  Spiralis — The  mature  trichina; — tlie  males 
being  about  one-eighteenth  and  the  females  about  one-eighth  of  an  inch 
long — live  in  the  intestines  for  six  or  eight  weeks.  They  never  reach 
the  soft  tissues  of  the  body,  In  which  their  young  larvae  are  so  abundant, 
"but  are  discharged,  from  time  to  time,  with  the  excreta  of  the  patient, 
either  alive  or  after  their  death  has  occurred. 

Discovery  of  Trichinse.- — Trichina;,  as  well  as  cysticerci,  were  first  dis- 
covered in  human  beings  in  the  dissecting  room,  by  Dr.  Simon,  in  1S35. 
Professor  Leidy  was  the  first  to  detect  them  In  the  pig.  They  were, 
however,  repeatedly  observed  without  their  true  import  being  ascertained 
l^til  1860,  when  Dr.  Zenker,   of  Dresden,   explained  their  origin   and 


Commencing 

Calcification 

of  Trichina  Cyst. 


750 


DISBASKS  OF  THE  BONKS  AND  IMUSCI.ES. 


relation  to  certain  symptoms  of  obscure  attacks  of  sickness,  and  described 
the  disease  trichinosis  or  trichiniasis.  In  the  same  year  Leukart  piiblished 
his  elaborate  and  trustworthy  investigations  upon  the  subject  of  the 
trichina.  Previous  to  ISCO  the  trichina  had  been  identified  only  once  in 
pork,  although,  as  occurring  in  man,  it  had  been  well  known  for  a  quarter 
of  a  century.  It  is  not  decided  how  it  will  retain  its  vitality  when  encysted 
in  human  muscles. 

Eemarkable  Vitality  of  the  Trichinae. — Professor  Langenbeck,  of  Ber- 
lin, has  reported  a  case  where,  in  removing  a  tumor  from  the  neck  of  a 
patient,  eighteen  years  after  the  man  had  an  attach  of  trichiniasis,  which 
passed  for  poisoning  at  the  time,  he  found  living  trichina;  in  the  frag- 
ments of  attached  muscles;  and  it  is  stated  on  good 
authority  that  they  have  been  known  to  exhibit  signs 
of  life  after  a  still  greater  lapse  of  time.    As  in  this 
instance,  before  Zenker's  discovery,  very  many  cases 
passed   for    jjoisoning,    for    typhoid    and    rheumatic 
fever,  and  for  other  diseases.     An  epidemic  involv- 
ing over  five  hundred  persons  in  Blankenberg,  Ger- 
many, was  treated  as  an  outbreak  of  gastro-rheumatic 
fever,  and  it  was  only  several  years  afterward  that 
the  attention  of  one  of  the  gentlemen  who  suffer(>d 
from  the  disease  being  called  to  Zenker's  discovery, 
he  submitted  to  an  operation  for  the  removal  of  a 
small  piece  of  one  of  his  pectoral  muscles,  in  which 
Trichina  and  Its  Cyst    encvstcd  trichina3  were  detected,  and  the  true  nature 

Completely  Calcified.  ^  ' 

of  the  disorder  which  had  affected  the  five  hundred 
patients  many  years  previously  was  revealed  for  the  first  time. 

Epidemics  of  Trichiniasis. — In  this  country  severe  epidemics  have 
oeciirred  in  Xew  York,  Mississippi  and  Iowa,  and  isolated  cases  are  from 
time  to  time  appearing  in  various  other  States.  In  1S75,  it  is  stated,  that 
there  were  some  eighty  cases  of  trichiniasis  in  Berlin,  and  about  seventy- 
five  near  Hanover.  A  group  of  cases  occurred  in  18S2  in  Bridesburg,  and 
another  near  'New  York.  In  1874:  there  was  quite  a  severe  epidemic  in 
the  family  of  a  pork  packer  residing  in  Buffalo,  N^ew  York.  The  disease 
is  as  rare  in  France  as  it  is  common  throughout  the  German  Empire. 

Vitalty  of  Trichinae  After  Death  of  Infected  Hog. — In  pork  the 
trichinae  may  be  found  either  encysted  or  naked  among  the  muscular 
fibres.  It  is  not  certain  how  long  they  may  live  after  the  pig  is  killed, 
but  they  are  known  to  be  capable  of  propagation  after  remaining  for 


DISEASES  OF  THE  MTJS0LE8. 


751 


one  hundred  days  in  putrid  pork.  The  frequency  of  the  disease  in  swine 
is  probably  as  great,  if  not  greater,  in  America  than  elsewhere ;  but  here 
mankind  is  not  so  often  infected,  because  less  raw  or  under-dono  sausage, 
ham,  bacon,  and  so  forth,  is  eaten  with  us  than  in  Eurojie.  Of  1,394  hogs 
taken  at  random,  and  examined  by  the  Chicago  Academy  of  Sciences, 
twenty-eight  were  found  to  be  infected  with  trichinae;  but  this  large  pro- 
jiortion  can  only  be  accounted  for  on  the  supposition  that  au  epidemic 
among  swine  Avas  then  raging. 

Method  of  Detecting  Trichinae — The  editor  of  the  American  Journal 
cf  Mici'oscopy  recommends  that  in  examining  the  flesh  of  swine  suspected 
of  being  infected  with  tricliinas,  the  following  method  should  be  adopted : 
The  parts  of  the  animal  to  be  first  tested  are  the  diajihragm,  the  tenderloin, 
and  the  muscles  of  the  head  and  throat.  In  the  ham,  the  most  likely  place 
to  find  the  parasites  is  Avhere  the  muscle  ends  in  tendon.  A  thin  slice 
should  be  cut  off  with  a  sharp  scalpel,  or  with  a  pair  of  scissors  curved  on 
the  flat.  This  thin  section  should  then  be  soaked  for  some  minutes  in 
acetic  acid,  spread  out  on  a  glass  slide,  and  covered  with  a  thin  glass  in 
the  ordinary  way ;  or,  if  the  section  happens  to  be  very  thick,  a  compres- 
sorium,  in  which  the  two  plates  of  glass  are  forced 
together  by  means  of  a  lever  and  screw,  will  be  found 
very  useful. 

A  little  instrument  constructed  on  the  plan  o£ 
the  compressorium,  and  called  a  "trichinoscope,"  is 
sold  to  supply  the  popular  demand  for  home  pro- 
tection against  triehiuic. 

Infected  Pork  Should  be  Destroyed All   pork 

which  has  been  found  to  contain  trichina?  should  be 
seized,  condemned  and  destroyed,  either  by  fire  or 
by  strong  mineral  acids,  siich  as  the  sulphuric  or 
nitric.  Mere  burying  of  2:)oisonous  meat  of  this  kind 
is  obviously  not  sufiicient.  Moreover,  the  question 
as  to  whether  owners  of  such  carcasses  should  not 
be  compensated  for  all  property  confiscated,  is  well 
worthy  of  consideration;  because  if  siich  was  the 
rule,  butchers  and  dealers  would  have  no  inducement  for  concealment  and 
fraudulent  sale. 

Only  Safe  Rule. — In  spite,  however,  of  any  apparently  perfect  system 
of  inspection,  such  as  that  adopted  in  Germany,  dangerous  meat,  from 
some  cause  or  other,  will  necessarily  escape  observation,  so  that  the  only 


Human  Muscle  Containin 
Calcified   .Trichinae. 
(Natural  Size.) 


?62  DISEASES  OF  THE  BONES  AND  MUSCLES. 

safe  rule  for  us  to  adopt,  and  to  urge  upou  everybody  else,  is  never  to 
cat  any  pork  •which  has  not  been  thoroughly  cooked. 

It  is  not  safe  to  trust  to  pickling  and  smoking,  even  when  these 
processes"  are  combined,  as  is  ordinarily  the  case,  and  it  must  be  borne 
in  mind  that  meat  is  seldom  thoroughly  cooked  when  cut  in  slices  more 
than  an  inch  thick. 

The  fact  that  two  dangerous  and  often  fatal  maladies  like  trichiniasis 
and  cysticercus  disease,  both  of  which  are  generally  beyond  the  reach 
of  medical  treatment  when  once  they  have  infected  the  human  system, 
are  not  infrequent  from  eating  pork  which  has  been  imperfectly  cooked, 
should  render  the  employment  of  this  culinary  precaution  in  regard  to 
all  meats  imiversal,  especially  as  it  is  a  safeguard  so  easily  applied. 

Myositis — This  affection  consists  in  an  inflammation  of  the  voluntary 
muscles,  and  may  arise  from  injury  to  or  overuse  of  a  miiscle,  from 
gout  or  rheumatism,  from  secondary  syphilis,  or  from  infection  followed 
by  suppuration. 

Treatment — The  treatment  for  injury  or  overuse  of  muscle  is  ab- 
solute rest  of  muscle  and  the  local  ajiplication  of  anod;)Tie  lotions. 

If  due  to  rheumatism  or  syphilis,  prompt  relief  wiR  follow  treatment 
appropriate  to  these  affections. 

Degeneraton  of  Muscles — Fatty  degeneration  is  occasionally  observed 
in  muscular  tissue — in  which  the  tissue  is  converted  into  a  fatty  granular 
mass. 

Treatment. — By  use  of  passive  motion,  massage  and  electricity  to  im- 
prove nutrition  of  the  muscles. 

Ossification — Ossification  of  a  portion  of  a  muscle,  or  more  fre- 
quently of  its  point  of  insertion  into  a  bone,  is  occasionally  observed  as 
a  result  of  long-continued  irritation.  Its  course  is  slow  and  unaffected  by 
treatment. 

Tumors. — Muscles  may  be  the  seat  of  cancerous,  syphilitic,  vascular, 
cartilaginous  or  osseous  growths.  The  treatment  depends  entirely  upon 
their  nature ;  non-malignant  growths  can  often  be  removed  by  dissection ; 
canceroiis  or  malignant  growths  involving  miiscles  of  the  extremities 
should  be  cut  out  or,  as  many  cases  call  for,  prompt  amputation  of  the 
limb. 


T/)e  /luscu/dr  System    Front  w/ew. 


COPVmOHT  I9ie    BYC.J  STANLtr 


DISEASBS  OF  THE  MUSOIiBS.  753 


THE  MUSCULAR  SYSTEM  (See  Adjoining  Plate). 

The  plate  presents  a  comprehensive  view  of  the  front  muscles  of  the 
body.     They  may  be  grouped  and  viewed  thus : 

Head  Muscles. — 1.  These  are  seen  above  the  eyes,  and  are  used  for 
elevating  the  upper  eyelids  and  corrugating  the  forehead. 

Face  Muscles — 2.  These  are  muscles  of  expression  and  mastication. 
Those  about  the  eyes  are  used  in  winking  and  opening  and  shutting.  Those 
seen  at  either  side  of  the  nose  lift  the  cheeks  and  lips.  Those  at  the 
sides  control  the  lower  jaw  in  eating. 

Neck  Muscles. — 3.  These  serve  to  lower  and  raise  the  head  and  turn 
it  from  side  to  side. 

Shoulder  Muscles — 4.  These  embrace  the  shoulders  and  upper  arm. 
They  are  the  great  lifting  and  hitting  muscles.  The  prominent  one  on 
the  upper  arm  is  the  biceps  muscle,  or  muscle  with  two  heads. 

Muscles  of  Forearm — 5.  These  control  rotary,  flexor  and  extensor 
motion,  from  the  elbow  to  the  wrist. 

Hand  Muscles — 6.  These  control  all  hand  motions — opening  and 
shutting,  i-otation,  flexor  and  extensor  movements. 

Chest  Muscles — 7.  These  are  radiating  from  sides  to  centre.  They 
control  the  twisting,  elevation  and  lowering  of  the  upper  part  of  the  body. 

Abdominal  Muscle — 8.  This  is  seen  in  the  centre,  in  white.  It  is 
intimately  connected  with  breathing  and  raising  and  lowering  the  dia- 
phragm. At  its  top  is  the  solar  plexus,  the  spot  upon  which  prizefighters 
seek  to  deliver  their  knockout  blows. 

Hip,  Thigh  and  leg  Muscles — 9.  These  powerful  muscles  cooperate 
for  every  kind  of  movement  and  exhibition  of  strength.  The  two  strap- 
like muscles  of  the  upper  leg  are  the  sartorial,  or  tailor's  muscles,  which 
enable  us  to  cross  our  legs. 

Lower  Leg  Muscles. — 10.  These  are  also  powerful,  and  possessed  of 
rotary,  flexor  and  extensor  power.  They  largely  control  the  feet  in  walk- 
ing, operating  clear  to  the  ankle  joint. 

Foot  Muscle — 11.  These  control  from  instep  to  toes,  each  toe  having 
its  elevating  and  depressing  muscle.  The  rotary  motion  of  the  foot  is 
imparted  wholly  from  the  ankle. 


18 


SLP  2 1 1993 


UC  IRVINE  LIBRARY 


3  1970  01015  4950 


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